Cardiac Tamponade

CARDIAC
TAMPONADE
INTRODUCTION
 Cardiac tamponade is a medical or traumatic
emergency that happens when enough fluid
accumulates in the pericardial sac compressing the
heart and leading to a decrease in cardiac output and
shock.
 The diagnosis of cardiac tamponade is a clinical
diagnosis that requires prompt recognition and
treatment to prevent cardiovascular collapse and
cardiac arrest.
 The treatment of cardiac tamponade can be performed
at the bedside or in the operating room.
ETIOLOGY
 Cardiac tamponade is caused by the buildup of
pericardial fluid (exudate, transudate, or blood) that
can accumulate for several reasons.
 Hemorrhage, such as from a penetrating wound to the
heart or ventricular wall rupture after an MI, can lead
to a rapid increase in pericardial volume.
 Other risk factors, which tend to produce a slower-
growing effusion, include;
 infection (tuberculosis [TB], myocarditis)
ETIOLOGY
 Autoimmune diseases.
 Neoplasms
 Uremia
 Inflammatory diseases (pericarditis).
 The pericardial fluid that builds up slowly is better tolerated in
patients than with rapid accumulations. Hence, traumatic causes
(hemopericardium) require small volumes to causes hemodynamic
instability versus pericardial effusions from medical causes such as
malignancy where large volumes of fluid may accumulate in
pericardial sac before patients become symptomatic.
PATHOPHYSIOLOGY
 Normally, a small, physiologic amount of fluid surrounds
the heart within the pericardium.
 When the volume of fluid builds up fast enough, the
chambers of the heart are compressed, and tamponade
physiology develops rapidly with much smaller volumes
 The classical example is the traumatic cardiac injury
resulting in hemp-pericardium.
 Under this pressure, the chambers of the heart are unable
to relax leading to decreased venous return, filling and
cardiac output
PATHOPHYSIOLOGY
 Slow growing effusions, such as those due to autoimmune
disease or neoplasms, allow for stretching of the pericardium,
and effusions can become quite large before leading to
tamponade physiology
 The fluid may be hemorrhagic, serosanguineous or chylous. The
underlying pathology behind cardiac tamponade is a decreased in
diastolic filling, which leads to a decreased cardiac output.
 One of the first compensatory signs is tachycardia to overcome
the reduced output.
 In addition, the compression also limits systemic venous return,
impairing filling of the right atrium and ventricle.
CLINICAL FEATURES
 Beck’s triad  Narrow pulse pressure
 Distant heart sounds  Dyspnea
 Distended jugular vein  Cyanosis of lips and nail
 Decreased arterial  Restlessness and anxiety

pressure  Muffled heart sounds
 Tachycardia
DIAGNOSIS
 History and physical exam
 ECG may be helpful, especially if it shows low voltages or
electrical alternans, which is the classic ECG finding in
cardiac tamponade due to the swinging of the heart within
the pericardium that is filled with fluid. This is a rare ECG
finding, and most commonly the ECG finding of cardiac
tamponade is sinus tachycardia. In severe cases, one may
note electrical alternans
 A chest x-ray may show an enlarged heart and may strongly
suggest pericardial effusion if a prior chest radiograph with
a normal cardiac silhouette is available for comparison
DIAGNOSIS CONT’
 Echocardiography is the best imaging modality to use at the
bedside, whether it is a point-of-care echo or a cardiology echo
study
 Echocardiography can not only confirm there is a pericardial
effusion, but determine its size, and whether it is causing
compromise of cardiac function (right ventricular diastolic collapse,
right atrial systolic collapse
 Blood work that may assist with the diagnosis include creatine
kinase levels, renal profile, coagulation profile, antinuclear
antibody tests, ESR, HIV testing
MANAGEMENT
The main aim;

 Save the patient’s life
 Improve heart function
 Relieve from symptoms
Management options include:

 IV fluids to maintain normal BP
 Antibiotics
 Supplemental oxygen to reduce work loadon the heart

PERICARDIOCENTESIS
 Surgical invasive procedure in which excessive or
abnormal fluid is removed from the pericardium sac
around the heart
 The pericardial fluid is removed by a needle for
diagnostic or therapeutic purposes
 Removal of 5 to 10ml may increase stroke volume and
cardiac output by 25 to 50% .Then reassess for
improvement.
 Can be repeated when necessary
MANAGEMENT CONT’
 Surgicaloptions include creating a pericardial window
or removing the pericardium
 Emergency department resuscitative thoracotomy and
the opening of the pericardial sac is a therapy that can
be used in traumatic arrests with suspected or
confirmed cardiac tamponade. These options are
preferable to needle pericardiocentesis for traumatic
pericardial effusions.
NURSING MANAGEMENT
 Assess the clients status
 Monitor hemodynamic[pulse,BP,RR]
 Assess neurologic status [LOC,

Orientation] ,Confusion ,restlessness and anxiety
 Provide psychological support
 Cardiovascular assessment
NURSING DIAGNOSIS
Decreased cardiac output related to reduced ventricular
filling secondary to increased intrapericardial pressure
Interventions;
 Continuously monitor ECG for dysrhythmia formation
which may result to myocardial ischemia secondary to
epicardial coronary artery compression
 Monitor the BP every 5 to 15mins during the acute phase
 Monitor urine output hourly. A drop may indicate

decreased renal perfusion as a result of decreased stroke
volume secondary to cardiac compression

Cardiac Tamponade

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CARDIAC

 Distended jugular vein  Cyanosis of lips and nail

 Decreased arterial  Restlessness and anxiety

The main aim;

 Improve heart function

 Relieve from symptoms

Management options include:

 Supplemental oxygen to reduce work loadon the heart

 Assess neurologic status [LOC,

 Monitor urine output hourly. A drop may indicate

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