Cardiac tamponade (Complete) Flashcards
Define cardiac tamponade
Accumulation and buildup of fluid within pericardial space under pressure
What are the main risk factors for cardiac tamponade?
Purulent pericarditis
Severe thoracic trauma (e.g. stab wound or car accident)
Malignancy
What are the main signs/symptoms of cardiac tamponade?
Symptoms:
Dysponoea
Tacchycardia
Confusion
Chest pain: Atypical non-exertional chest pain
Abdominal pain: Secondary to hepatic congestion
Signs: Beck’s triad
Hypotension
Quiet heart sounds
Raised JVP (absent Y descent)
Pulsus paradoxus: Cardiac output /BP reduced on inspiration
What is characteristic of cardiac tamponade chest pain?
Atypical chest pain
Non-exertional
What is triad is indicative of cardiac tamponade?
Beck’s triad:
Hypotension
Raised JVP
Quiet heart sounds
What investigations should be considered in patients suspected of cardiac tamponade?
Bedside:
ECG: Tacchycardia, electrical alternans and/or small QRS complexes
Basic obs: Hypotension
Bloods:
FBC: Baseline, WCC may point towards pericarditis causes
ESR/CRP: May be raised in pericarditis
Troponin: Raised in MI or trauma
G&S
Imaging:
CXR: Rule out other causes
ECHO: Demonstrate fluid in sac and ventricular comprimise
Pericardiocentesis: Diagnostic and therapeutic (fluid analysis for underlying cause and drain fluid)
What ECG findings are indicative of cardiac tamponade?
Tacchycardia
Electrical alternans
Low voltage QRS complexes
What is electrical alternans?
Varying QRS amplitudes between beats
What is management plan for patients with cardiac tamponade?
Invasive:
Urgent pericardiocentesis (especially if clinically unstable)
Surgical drainage: If haemopericardium (secondary to malignancy, trauma or purulent)
What are major complications of pericardiocentesis? (4)
Pneumothorax
Myocardial damage
Coronary vessel damage
Arryhthmia/cardiac arrest
What imaging must be done in all patients following pericardiocentesis procedure?
CXR
To check for pneumothorax complications
