Cardiac Tamponade

Question 1

Define cardiac tamponade

Answer 1

A complication of pericarditis where a large volume of fluid accumulates in the pericardial space, impairing ventricular filling

Question 2

Describe the pathophysiology for cardiac tamponade

Answer 2

• Following on from pericarditis, there is too much exudation which leads to an accumulation of fluid in the pericardial space
• This can lead to raised intrapericardial pressure which compresses the heart and reduces cardiac output due to ventricular filling being impaired

Question 3

What are symptoms of cardiac tamponade?

Answer 3

• Shortness of Breath
• Tachycardia
• Confusion
• Chest Pain
• Abdominal Pain

+ Pericarditis symptoms

Question 4

What are the signs of cardiac tamponade?

Answer 4

Beck’s Triad:

• Raised Jugular Venous Pressure (JVP)
• Hypotension
• Muffled Heart Sounds

Pulsus Paradoxus: Reduction of systolic blood pressure (~10mmHg) on inspiration

Question 5

What is used to diagnose cardiac tamponade?

Answer 5

• ECG
• Transthoracic Echo
• Chest X-Ray

Question 6

What does an ECG show for cardiac tamponade?

Answer 6

May show electrical alternations

Question 7

What does transthoracic ECHO show for cardiac tamponade?

Answer 7

Gives better idea on how much fluid there is around the heart

Question 8

What does CXR show for cardiac tamponade?

Answer 8

Big Globular Heart

Question 9

What is first line treatment for cardiac tamponade?

Answer 9

Urgent Pericardiocentesis (sticking in a needle to drain fluid) is first line if they are haemodynamically unstable

Question 10

Where is the needle inserted for urgent pericardiocentesis?

Answer 10

The needle is inserted between the xiphisternum and left costal margin and directed towards left shoulder

Question 11

What treatment is there for haemodynamically stable cardiac tamponade patients?

Answer 11

If a patient is haemodynamically stable, you just carefully observe them with ECHOs and IV Fluid treatment to help maintain ventricular filling