This provides a summary of Cardiac Tamponade as a condition including the background, symptoms and signs/clinical presentation, investigations to diagnose the condition and management plan.
CARDIAC TAMPONADE
Cardiac tamponade = life threatening condition caused by compression of the heart due to accumulation of blood, fluid,
clots or gas within the pericardial space, preventing adequate filling and contraction.
The presentation depends on speed of development of the tamponade.
§ Chest pain
§ Dyspnoea
§ Collapse
§ Fatigue
§ Peripheral oedema
§ Tachycardia
§ Pulsus paradoxus
§ Pericardial rub
§ Features of shock ® cool peripheries, peripheral cyanosis, reduced urine output.
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Pathophysiology
A cardiac tamponade occurs due to a pericardial effusion (excess fluid or other substance) within the pericardial space.
§ Normal pericardial sac contains 20-50 ml of pericardial fluid
§ Excess fluid may accumulate in the pericardial sac due to:
o Inflammation and increased fluid production
o Reduced reabsorption from increased venous pressure
o Haemorrhage into the sac
§ Can be classified according to four factors:
o Onset ® acute, subacute, chronic (>3 months)
o Size ® mild (<10 mm), moderate (10-20 mm), large (>20 mm)
o Distribution ® circumferential, loculated
o Composition ® transudate, exudate
§ Effusion can lead to ® increased pericardial pressure ® compression of all heart chambers
§ Acute accumulation of fluid ® rapid development of haemodynamic compromise
§ Common causes of tamponade:
o Pericarditis, TB, iatrogenic (e.g. post-invasive cardiac procedure), trauma, malignancy
§ Uncommon causes of tamponade:
o Connective tissue disease, radiation, uraemia, post-MI, aortic dissection, bacterial infection
§ The main issue in tamponade is compression of the heart chambers due to increased pericardial volume
o As pressure increases, chambers become smaller and there is decreased diastolic compliance
o Tamponade reduces venous return ® restricts ventricular filling ® reduced SV and CO
o End result = decrease in BP and haemodynamic compromise
§ Pulsus paradoxus ® decrease in systolic arterial BP >10 mmHg during inspiration
o During inspiration, venous return normally increases to the right side of heart and pulmonary venous return
decreases to left side
o When heart is compressed, only the interventricular septum distends partially on inspiration
o Septum bulges into the left ventricle, further impeding ventricular filling
o Causes greater fall in BP.
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Investigation
This requires an urgent echocardiogram.
Echocardiogram
§ Features include:
o Chamber collapse ® early diastolic collapse of RV and late diastolic collapse of RA
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