Cardiac tamponade

Question 1

Describe the mechanism of cardiac tamponade/pericardial effusion

Answer 1

Cardiac tamponade occurs when the accumulation of fluid, blood, purulent exudate or air in the pericardial space raises the intra pericardial pressure.
Diastolic filling is reducing thereby reducing the cardiac output.
It is a life threatening emergency.

Question 2

What is the eponymous group of signs, used to describe the clinical presentation of cardiac tamponade?

Answer 2

Beck’s triad:
Hypotension
Quiet heart sounds
Raised JVP

Question 3

What are the symptoms of pericardial effusion?

Answer 3

Shortness of breath
Tachycardia
Confusion
Chest pain
Abdominal pain
Orthopnoea
Pulsus paradoxus

Question 4

What is the classic sign of pericarditis?

Answer 4

Pericardial rub

Question 5

What are the non- cardiac symptoms of cardiac tamponade? How do they occur?

Answer 5

Compression of structures:
Phrenic nerve- hiccups
Oesophagus- dysphagia
Recurrent laryngeal nerve- hoarse voice

Question 6

What investigations are done in suspected cardiac tamponade? Explain each

Answer 6

Urgent echocardiogram- diagnosis, size of effusion, haemodynamic effect (compression on heart)
Fluid analysis (paracentesis)- to investigate cause:
Protein content, bacterial culture, viral PCR, cytology and tumour markers

Question 7

What are the risk fx for cardiac tamponade?

Answer 7

Malignancy
Purulent pericarditis
Severe thoracic trauma

Question 8

What are the causes of cardiac tamponade? Divide answer into transudative and exudative

Answer 8

Transudate:
CHF, pulmonary HTN
Exudate:
Infection (e.g., tuberculosis, HIV, coxsackievirus, Epstein–Barr virus and other viruses)
Autoimmune and inflammatory conditions (e.g., systemic lupus erythematosus and rheumatoid arthritis)
Injury to the pericardium (e.g., after myocardial infarction, open heart surgery or trauma)
Uraemia (raised urea) secondary to renal impairment
Cancer
Medications (e.g., methotrexate)

Question 9

How is pericardial effusion managed?

Answer 9

Treat underlying cause
Drainage of the effusion, where required (if haemodynamically unstable):
- Needle pericardiocentesis
- Surgical drainage, first line in: haemopericardium, associated malignancy, traumatic/purulent effusion

Question 10

What are the complications of needle pericardiocentesis?

Answer 10

Pneumothorax

Damage to surrounding structures