Cardiac Tamponade Flashcards
What is a cardiac tamponade?
Accumulation of fluid, blood, purulent exudate or air in the pericardial space (space between 2 layers)
Initially it can be a pericardial effusion where there is fluid which inward pressure however if large enough it may raise the intra-pericardial pressure and now is known as a tamponade
What is the overall effect of a tamponade in the physiology of the heart?
Harder to fill during diastole, results in decreased cardiac output during systolic
What are the 3 general causes of a cardiac tamponade?
a. Increased venous pressure e.g., CHF & pulmonary hypertension
b. Inflammatory process e.g., infection, injury during surgery, medication and cancer
c. rupture of heart or aorta e.g., trauma, myocardial infarction and aortic dissection
Are symptoms dependent on the speed at which the effusion develops?
Yes
What are the symptoms of a slow developing, chronic effusion?
Chest pain
Sob
Feeling of fulness in chest
Orthopnoea when lying flat
Cardiac tamponade, may cause compression of the surrounding structure, what structures and symptoms would this be?
a. Hiccups due to phrenic nerve compression
b. Dysphagia - oesophageal compression
c. Hoarse voice - recurrent laryngeal nerve compression
Would the BP be high or low?
Low –> Hypotension
Another sign is pulses paradoxes, what is this?
An abnormally large fall in BP pressure during inspiration notable when palpating pulse
What may happen to the JVP during Cardiac tamponade?
Raised JVP - an absent Y descent on the JVP - this is due to the limited right ventricular filling
When auscultating the heart, what would you notice?
Quiet heart sounds
Generally Beck’s Triad is used to remember the signs, what are they?
- Hypotension
- Quiet heart sounds
- Raise JVP
What are the risk factors for a cardiac tamponade?
Malignancy, purulent pericarditis or severe thoracic trauma
What are the 4 investigations you should carry for diagnosis?
ECG - may show low voltage QRS complexes or electrical alternans
Chest X-ray - may show a large globular heart
ECHO - will demonstrate the amount of fluid around the heart and quantify the level of ventricular compromise.
Pericardiocentesis - will allow for sampling of the fluid to find the underlying cause and treat the immediate problem.
What are the 2 options for effusion drainage?
needle pericardiocentesis - haemodynamically unstable patient
Surgical drainage - if trauma, malignancy, haemopericardium
What are the complications of pericardiocentesis?
Pneumothorax - all patient should have post procedure CXR
damage to the myocardium, coronary vessels, thrombus, arrhythmias/cardiac arrest and damage to the peritoneum.
