Tamponade

Question 1

What is tamponade?

Answer 1

Collection of fluid in the pericardial space.

Question 2

What form of shock does tamponade cause?

Answer 2

Cardiogenic

- Reduced cardiac output due to ability of the ventricles to fill

Question 3

What causes tamponade?

Answer 3

• Iatrogenic
• Trauma
• Malignancy
• Pericarditis
• TB

Question 4

What happens on inspiration?

Answer 4

The volume of the left heart decreases (Ventricular interdependence)
1- Inspiration augments venous return
2- RA/RV volumes increase
3- Increased volume pushes septum across to left side

Question 5

What does ventricular interdependence cause?

Answer 5

Pulsus paradoxus

- Inspiratory drop in BP of more than 10mmHg due to deviation of the ventricular septum

Question 6

How does tamponade present?

Answer 6

• Dyspnoea
• Atypical chest pain, at rest
• Risk factors e.g. malignancy, TB, pericarditis history

Question 7

What signs might you see with tamponade?

Answer 7

• Beck’s Triad
• Pulsus paradoxus
• Tachycardia
• Scars from a recent procedure

Question 8

What is Beck’s Triad?

Answer 8

• Raised JVP
• Hypotension
• Muffled heart sounds

Question 9

What imaging may be used?

Answer 9

• CXR- enlarged cardiac silhouette

- ECHO- collapsed chambers

Question 10

What bloods may be useful?

Answer 10

• WBC and differential
• Cardiac enzymes (Trop and CK-MB)
• ESR raised

Question 11

When would tamponade be medically treated?

Answer 11

• Pulsus paradoxus is less than 10mmHg

- Haemodynamically stable (sys is 110+)

Question 12

How would you medically treat a tamponade?

Answer 12

• NSAIDs
• Gastroprotection (PPI)
• Followup/direct patients for what to do if they become symptomatic again

Question 13

How would you treat unstable tamponade?

Answer 13

Pericardioscentesis

Or surgical drainage if it is traumatic/neoplastic

Question 14

What are the complications of tamponade?

Answer 14

ROAD

• Recurrence
• Organ hypoperfusion
• Arrest (Cardiac)
• Death