E: Cardiac Tamponade

Question 1

Defined pericardial effusion

Answer 1

Accumulation of fluid within the pericardial space

Question 2

What can cause pericardial effusion

Answer 2

• Pericarditis
• Stab wound of the pericardium in surgery, trauma, post MI
• aortic dissection

Question 3

How will pericardial effusion present clinically

Answer 3

• Dyspneoa
• Chest pain
• Bronchial breathing
• Nausea
• Hiccups

Question 4

Why may an individual have hiccups in pericardial effusion

Answer 4

Due to compression of the phrenic nerve

Question 5

What is Ewart’s sign

Answer 5

Bronchial breathing in pericardial effusion caused by compression of the lower lobe

Question 6

How will heart sounds present in pericardial effusion

Answer 6

Muffled heart sounds

Question 7

What 4 investigations may be ordered in pericardial effusion

Answer 7

1. ECG
2. CXR
3. ECHO
4. Pericardiocentesis

Question 8

What will a chest x-ray show in pericardial effusion

Answer 8

If fluid volume is more than 300ml it will show an enlarged globular heart

Question 9

What will a ECG in pericardial effusion

Answer 9

Electrical alternans

Question 10

What will an ECHO show in pericardial effusion

Answer 10

Free fluid space surrounding the heart

Question 11

When is pericardiocentesis performed

Answer 11

If bacterial cause is suspected (pericarditis)

Question 12

What is the treatment of pericardial effusion

Answer 12

Pericardiocentesis can be therapeutic. Underlying cause should be addressed

Question 13

What is the major complication of pericardial effusion

Answer 13

Cardiac tamponade. Where accumulation in pericardium causes compression of the heart

Question 14

What is cardiac tamponade

Answer 14

accumulation of fluid within the pericardium that compresses the heart

Question 15

What are the two types of fluid that can accumulate in the pericardium

Answer 15

• Haemopericardium (blood)

- Serous fluid

Question 16

What are 4 causes of haemopericardium

Answer 16

• Cardiac surgery
• MI causing rupture of wall
• Aortic dissection
• Trauma

Question 17

What are 5 causes of serous pericardial effusion

Answer 17

• Pericarditis
• Uremic syndrome
• Hypothyroidism
• Autoimmune conditions
• Malignancy

Question 18

What are the symptoms of cardiac tamponade

Answer 18

• Reterosternal chest pain
• Orthopneoa
• Dyspnoea

Question 19

What is Beck’s triad

Answer 19

It is a triad of symptoms/signs seen in cardiac tamponade and includes

1. Hypotension
2. Muffled heart sounds
3. Raised JVP

Question 20

What sign will be present in cardiac tamponade

Answer 20

Kussmaul’s sign

Question 21

What is kussmaul’s sign

Answer 21

JVP rises on inspiration

Question 22

what pulse is present in cardiac tamponade

Answer 22

Pulsus paradoxus

Question 23

what is pulses paradoxes

Answer 23

pulse decreases on inspiration

Question 24

explain JVP in cardiac tamponade and why this occurs

Answer 24

there is an absent Y descent, as there is limited right ventricle filling due to reduced area.

Question 25

explain the pathophysiology of cardiac tamponade

Answer 25

Increase in pressure in the pericardial space compresses the heart that decreases ventricular diastolic filling, stroke volume and cardiac output.

Question 26

how is cardiac tamponade diagnosed

Answer 26

Clinical

Question 27

what is the management of cardiac tamponade

Answer 27

Pericardiocentesis

Question 28

if an individual has recurrent episodes of cardiac tamponade, what should be done

Answer 28

Pericardectomy

Question 29

what are two complications of cardiac tamponade

Answer 29

• Cariogenic shock - due to decreased output

- Asystole