Cardiac Tamponade

Question 1

What is Cardiac tamponade?

Answer 1

It is caused by the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling & subsequent hemodynamic compromise.

The pericardia space normally contains 20-50ml of fluid.

The amount of fluid needed to impair diastolic filling of the heart depends on the rate of accumulation and the compliance of the pericardium.

Rapid accumulation of as little as 150ml can severely impede cardiac output, whereas 1000ml of fluid may accumulate over a longer period without any significant effect on diastolic filling due to adaptive stretching of the pericardium over time.

Question 2

Presentation of Cardiac Tamponade?

Answer 2

• Patient present with dyspnoea, tachycardia & tachypnoea
• Cold & Clammy extremities from hypo-perfusion are also observed in some patients.
• Diminished heart sounds & pericardia friction rub are present in approximately one third of patients.
• Beck’s triad refers to increased jugular venous pressure, hypotension & diminished heart sounds.
• Pulsus paradoxus is an exaggeration ( <12mmHg or 9%) of the normal inspiratory decrease in systemic blood pressure.
• Kussmal sign is a paradoxical increase in venous distention & pressure during inspiration.
• Ewart sign or Pins sign is observed in patients with large pericardia effusions & is described as an area of dullness, with bronical breath sounds & bronchophony below the angle of the left scapula.

Question 3

Investigation for Cardiac Tamponade?

Answer 3

• Chest radiography may show cardiomegaly, water bottle- shaped heart or pericardial calcifications.
• ECG: shows sinus tachycardia, low voltage QRS complexes, electrical alternans (alternation of QRS complexes, usually in a 2:1 ratio) & PR segment depression.
• Echocardiography provides useful information, cardiac tamponade is a clinical diagnosis.

Question 4

Management of Cardiac tamponade?

Answer 4

Treatment is pericardiocentesis