Cardiac tamponade Flashcards
what is the definition of cardiac tamponade?
Cardiac tamponade is the accumulation of pericardial fluid, blood, pus, or air within the pericardial space that creates an increase in intra-pericardial pressure, restricting cardiac filling and decreasing cardiac output.
what is the epidemiology of cardiac tamponade?
Related to causative condition
More common in middle aged to older population
what is the aetiology of cardiac tamponade?
In symptomatic patients, the etiologies are most commonly iatrogenic (after cardiac surgery or intervention), trauma, malignancy, and idiopathic effusion
Postoperative tamponade is more common after valve surgery than after coronary artery bypass graft, and occurs more often in patients undergoing anticoagulation
what are the risk factors for cardiac tamponade?
Malignancy Aortic dissection Purulent pericarditis Large idiopathic pericardial effusion Iatrogenic-related hemorrhage TB
what is the pathophysiology of cardiac tamponade?
In classic tamponade, pericardial pressures are elevated because of accumulation of fluid in the pericardial space. Ventricular diastolic, right atrial, and wedge pressures all rise to equal pericardial pressures in an attempt to prevent chamber collapse. This equalisation of pressures is the haemodynamic hallmark of tamponade. Once the pericardial pressure exceeds intra-chamber pressures, the chamber will collapse.
what are the key presentations of cardiac tamponade?
Malignancy Presence of risk factors dyspnoea Elevated jugular venous pressure Distance heart sounds Pulsus paradoxus Hypotension Tachycardia Recent invasive cardiac intervention
what are the signs of cardiac tamponade?
Malignancy Presence of risk factors dyspnoea Elevated jugular venous pressure Distance heart sounds Pulsus paradoxus Hypotension Tachycardia Recent invasive cardiac intervention
what are the symptoms of cardiac tamponade?
Chest pain Abdo pain Confusion Fever Pericardial rub
what are the first line and gold standard investigations for cardiac tamponade?
ECG - low voltage, electrical alternans, electromechanical dissociation
Transthoracic echocardiogram - large pericardial effusion (defined as >20 mm of echo-free space in diastole between the visceral and parietal pericardium); chamber collapse and respiratory variation of ventricular filling
CXR - enlarged cardiac silhouette
FBC - raised WBC, low Hb
Erythrocyte sedimentation rate - elevated
Cardiac enzymes - elevated
what are the differential diagnoses for cardiac tamponade?
Constrictive pericarditis
Restrictive cardiomyopathy
Cardiogenic shock
how is cardiac tamponade managed?
Stable:
Anti Inflammatory treatment with gastroprotection and observation
Unstable:
Pericardiocentesis, drainage
how is cardiac tamponade monitored?
While routine imaging after drainage is not recommended to detect re-accumulation, patients should be followed up closely clinically for the development of symptoms.
what are the complications of cardiac tamponade?
Recent of refractory pericarditis and pericardial effusion
Organ hypoperfusion
Cardiac arrest effusive-constrictive pericarditis
what is the prognosis of cardiac tamponade?
For medical tamponade, mortality has been most closely associated with the causative disease. Patients with underlying malignancy had the highest rate of mortality.
