Cardiac tamponade

Question 1

What is cardiac tamponade?

Answer 1

A life-threatening condition characterised by the accumulation of pericardial fluid that causes a rise in intrapericardial pressure, compressing the inferior vena cava and heart chambers compromising ventricular filling and leading to reduced cardiac output.

Question 2

Why does cardiac tamponade occur?

Answer 2

The accumulation of fluid, blood, purulent exudate or air in the pericardial space raises the intra pericardial pressure.

Subsequently, diastolic filling is reducing thereby reducing the cardiac output.

Question 2

Symptoms/signs of cardiac tamponade?

Answer 2

Beck’s triad:
- hypotension
- raised JVP
- muffled heart sounds

SOB
Tachycardia
Confusion
Chest pain
Abdominal pain
Quiet heart sounds
Pulsus paradoxus (pulse fades on inspiration)

Question 3

IVx for cardiac tamponade?

Answer 3

ECG - may show low voltage QRS complexes or electrical alternans.
CXR - may show a large globular heart.
TTE -may show amount of fluid around the heart and quantify the level of ventricular compromise.
Pericardiocentesis -sampling fluid

Question 4

Management of cardiac tamponade?

Answer 4

1st line = pericardiocentesis (if haemodynamically unstable)

IV fluids -maintain ventricular filling

Question 5

Complications of cardiac tamponade?

Answer 5

Pneumothorax (all pts to have CXR post procedure)
Bloods clots
Arrhythmias
Cardiac arrest