5.3 Tamponade

Question 1

Q3 — Cardiac tamponade
You are asked to review a 65-year-old woman on the cardiac intensive care
unit who has undergone coronary artery bypass surgery earlier in the day.

a) List any six clinical features that might suggest the development of cardiac tamponade.

Answer 1

● Sudden increase or decrease in drain output.

● Tachycardia.

● Hypotension.

● Reduced urine output.

● Dyspnoea.

● Decreased consciousness/disorientation.

● Muffled heart sounds.

● Pulsus paradoxus.

Beck’s triad — hypotension, engorged neck veins and muffled heart
sounds.

Question 2

b) Name four investigations with their findings that could confirm
the diagnosis of cardiac tamponade.

Answer 2

● Reduced cardiac output.

● Raised CVP.

● ECG — electrical alternans.

● Echocardiogram — compression of heart chambers.

● CXR — enlarged heart.

**● PA catheter — equalisation of pressures in heart chambers.

Question 3

c) Outline the key steps of acute cardiac tamponade management in this patient.

Answer 3

● Immediate sternotomy if in extremis.

● Induction in theatre.

● Surgeon scrubbed and ready.

● Blood available.

● Large-bore access.

● Careful induction — ketamine could be useful.

● Fluids and vasopressors to
maintain coronary perfusion pressure.

Question 4

d) Name any two other causes of cardiac tamponade.

Answer 4

● Trauma.

● Iatrogenic damage during
intracardiac pressure studies.

● CVP or PA catheter insertion procedures.

● Iatrogenic injury during coronary
angiography and stenting.

● Heart chamber laceration
during pericardiocentesis.