Cardiac tamponade

Question 1

Pathophysiology?

Answer 1

Caused when there is an accumulation of pericardial fluid under pressure constricting the heart

Question 2

What triad of symptoms is present and what is the triad?

Answer 2

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

Question 3

What other symptoms and signs can be present?

Answer 3

• dyspnoea
• tachycardia
• an absent Y descent on the JVP - this is due to the limited right ventricular filling
• pulsus paradoxus
• Kussmaul’s sign - much debate about this

Question 4

What is pulsus paradoxus?

Answer 4

An abnormally large drop in BP during inspiration

Question 5

What is seen on ECG?

Answer 5

Electrical alternans

Question 6

What are the key differences between this condition and constrictive pericarditis?

Answer 6

Cardiac tamponade:

• Absent Y descent
• Pulsus paradoxus present
• Kussmaul’s sign is rare

Constrictive pericarditis:

• X + Y present
• Pulsus paradoxus absent
• Kussmaul’s sign present
• Characteristically has pericardial calcification on chest x-ray

Question 7

Mnemonic to remember the absent Y descent in cardiac tamponade?

Answer 7

TAMponade = TAMpaX

Question 8

Management?

Answer 8

Urgent pericardiocentesis

Question 9

What is electrical alternans?

Answer 9

Electrical alternans is defined as alternating QRS amplitude that is seen in any or all leads on an electrocardiogram (ECG) with no additional changes to the conduction pathways of the heart