Cardiac tamponade

Question 1

What is cardiac tamponade?

Answer 1

Pericardial effusion causing raised intrapericardial pressure, severely limiting ventricular dilatation and filling. This drastically compromises CO.
Cardiac tamponade can cause PEA.

Question 2

What is the difference between cardiac tamponade and an effusion?

Answer 2

Cardiac tamponade impairs haemodynamics.

Question 3

What are the causes of cardiac tamponade?

Answer 3

1. Pericarditis
2. Aortic dissection
3. Warfarin
4. Trans-septal puncture during cardiac catheterisation
5. Cardiac biopsy
6. Haemodialysis

Question 4

What signs would you expect to see in cardiac tamponade?

Answer 4

Raised pulse 
Lower blood pressure
Pulsus paradoxus
Raised JVP
Kussmaul's sign 
Muffled S1 & S2
Weak pulses

Question 5

What symptoms would you expect a patient with tamponade to present with?

Answer 5

Breathlessness
Syncope
Chest pain
Tachycardia

Question 6

What does Beck’s triad suggest?

Answer 6

Cardiac tamponade.

Raised JVP, hypotension & quiet or muffled heart sounds.

Question 7

What investigations would you perform for cardiac tamponade?

Answer 7

1. CXR - large, globular heart
2. ECG - low voltage QRS +/- electrical alternans
3. Echo -diagnostic; echo-free zone of >2cm (>1cm if acute) around the heart +/- diastolic collapse of the right atrium and right ventricle
4. Bloods
5. Sample pericardial fluid and send for culture, ZN stain/TB culture and cytology

Question 8

How do you treat cardiac tamponade?

Answer 8

Seek expert help.

The fluid needs urgent drainage = pericardiocentesis.