Cardiac Tamponade

• What is cardiac tamponade?


  Accumulation of pericardial fluid, blood, pus, or air within the pericardial space

  Creates increase in intra-pericardial pressure -> restricts cardiac filling -> decreased CO

  Medical emergency
• Pathophys of cardiac tamponade


  Fluid accumulates in pericardial space → raises pericardial pressure → equalisation of pressures in ventricles, right atrium & pulmonary wedge to prevent chamber collapse → when pericardial pressure surpasses intracardiac pressures → heart chambers collapse → inspiration increases negative intra-thoracic pressures & augments venous return to R heart → increased volume in R heart → forces intra-atrial & intra-ventricular septums into L heart (ventricular interdependence) → volumes in L heart decrease with inspiration → decreased CO & drop in BP
• What are the signs & symptoms of cardiac tamponade?


  SOB

  Chest pain

  Abdo pain

  Confusion

  Fever

  Raised JVP

  Distant heart sounds

  Pulsus paradoxus

  Hypotension

  Tachycardia

  Pericardial rub
• What is pulsus paradoxus?


  Abnormally large decrease in BP & pulse amplitude during inspiration
• What are the RFs of cardiac tamponade?


  Malignancy

  Aortic dissection

  Purulent pericarditis

  Large idiopathic pericardial effusion

  TB

  Iatrogenic-related haemorrhage

  Autoimmune disease

  Hypothyroidism

  Uraemia & renal failure

  Anticoagulation
• What are the Inx of cardiac tamponade?

  Obs

  Full Hx & examination

  ECG

  Bloods (FBC, U&Es, LFTs, CRP, cardiac enzymes)

  Echo

  CXR

  Cardiac catheterisation

  Pericardiocentesis (treatment, but fluid should be sent for culture & cytology)
• Why is cardiac catheterisation done in cardiac tamponade?


  Direct measurement of haemodynamic effects of tamponade

  Useful to differentiate tamponade from constrictive pericarditis or restrictive cardiomyopathy
• What would an ECG show in cardiac tamponade?


  low QRS voltage
• What are the DDx of cardiac tamponade?


  Constrictive pericarditis

  Restrictive cardiomyopathy

  Cardiogenic shock
• What is the criteria of pre-tamponade?

  Haemodynamically stable

  Systolic > 110 mmHg

  Pulsus paradoxus < 10 mmHg
• What is the treatment of pre-tamponade?


  NSAID/colchicine + PPI

  Observation
• What is the treatment of tamponade?

  Pericardiocentesis (if no haemorrhage, trauma, neoplasm)

  Surgical drainage