Cardiac Tamponade
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Introduction
Tamponade is a life-threatening complication of a pericardial effusion with rapid accumulation.
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Penetrating or blunt chest trauma can result in tamponade.
Pathophysiology
Increasing intra-pericardial pressure leads to decreased venous return and diastolic filling. Decreased cardiac output therefore leads to hypotension and venous congestion.
Signs and Symptoms
- history
- physical exam
History
Physical Exam
The classic findings of tamponade are:
- hypotension
- elevated JVP
- tachycardia
- pulsus paradoxus: an abnormally large drop in BP with inspiration: >10 mmHg
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
Central venous pressure can be elevated, though this is not specific.
ECG can show
echocardiogram
ultrasound, include FAST (focused assessment by sonography in trauma) is 90-95% specific if the operator is sufficiently trained. False negatives and positives can be seen with hemothorax.
Differential Diagnosis
Treatments
Intravenous fluids should be given to raise blood pressure; this can also increase cardiac output.
If the patient is unstable and fluid resuscitation is unsuccessful, pericardiocentesis can be carried out. Ideally, however, a surgeon should carry out the treatment, in the operating room if possible.
Pericardiocentesis is a temporary procedure, and may be unsuccessful if the blood has clotted. Definitive surgical exploration and repair is needed.
Pericardiotomy may be done by a trained surgeon.
Avoid diuretics and vasodilating medications.
Consequences and Course
Resources and References
Topic Development
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