Cardiac Tamponade

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Cardiac tamponade is the result of compression of the myocardium by fluid, gas, pus, blood, or a  combination of substances. It occurs in a physiologic continuum reflecting the amount of fluid, the  rate of accumulation, and the nature of the heart.   

The  result  is  increased  pericardial  pressure,  which  causes  decreased  ventricle  compliance  and  decreased flow of blood into the right ventricle which eventually leads to a decreased cardiac output.  Conditions  that  may  predispose  a  patient  to  pericardial  effusion  and  tamponade  include;  trauma,  radiation exposure, Tb pericarditis, renal failure (uremic pericarditis), autoimmune diseases, drugs  that induce a lupus-like syndrome, hypothyroidism, or ovarian hyperstimulation syndrome.  

Clinical presentations 

• Chest pain and dyspnea
• Pulsus paradoxus >10 mm Hg
• Beck’s  triad  includes  low  blood  pressure,  elevated  jugular  venous  distention,  and decreased heart sounds.
• In the absence of hypotension and tension pneumothorax in a patient with PEA, consider the diagnosis of cardiac tamponade.

Investigations 

Bedside  ultrasound,  POC  ECG,  Blood  gases,  Serum  Electrolytes,  Troponins,  Pericardial  fluid  analysis- biochemistry, microbiology and cytology, Serum creatinine and urea and/or Chest Xray 

Non pharmacological and pharmacological treatment 

• Perform both primary and secondary assessment and provide appropriate interventions.
• Give oxygen if hypoxic or increased work of breathing
• Connect the patient to a cardiac monitor and obtain vital signs
• Pericardiocentesis is the definitive management

Pharmacological treatment 

A: 0.9% sodium chloride (IV): Adults 1-2 lts, Paediatrics 20ml/kg) to increase right sided filling pressure 

Disposition 

All  patients  with  cardiac  tamponade  require  inpatient  management  in  an  intensive  care  unit  setting/HDU.