About pericardial effusion and cardiac tamponade

1. CARDIAC TAMPONADE
SREELAKSHMI RAJEEV
PHARM D V YEAR

2. CARDIAC TAMPONADE
• Tamponade : Pressure
• It is a condition that is caused due to the accumulation of fluid in pericardial sac
(pericardial effusion).
LAYERS OF HEART : There are 3 layers for heart.
i. Pericardium
ii. Myocardium
iii. Endocardium

3. PERICARDIUM
There are two layers of pericardium viz.
a) Outer Parietal layer : both fibrous
and serous
b) Inner Visceral layer [Epicardium] :
only serous

4. Pericardial Effusion [PE]
• It is the condition of abnormal accumulation of fluid in pericardial cavity.
• Normally 50 ml of fluid is present in the pericardial cavity.
• When the sac fills slowly it will expand and can contain more than 2 L.
• But when the sac fills rapidly as little as 200 ml can cause tamponade.
CAUSES FOR PE
• Inflammation due to heart surgery or attack
• Cancer of pericardium
• Auto immune disorders like RA or SLE.
• Uremia
• Viral, Bacterial, or Fungal infections.
• Certain drugs like hydralazine, INH, Phenytoin.

6. MANAGEMENT
• NSAIDs :To treat PEs caused by inflammation.
• Antibiotics :To treat PEs caused by infections.
• Diuretics :To treat PEs caused by heart failure.
ProceduresTo Drain Fluid
i. Ultrasound-guided Pericardiocentesis : It is a procedure done to remove
fluid hat has built up in pericardium. It is done using a needle and a small
catheter to drain excess fluid.
ii. Video-assisted thoracoscopic surgery (VATS) [Thoracoscopy] : It is
minimally invasive procedure done under GA. It allows visual evaluation of
the pericardium and is used when the diagnosis of pericardial effusion has
remained undiagnosed despite previous, less-invasive tests.
iii. Subxyphoid Pericardiostomy (PericardialWindow) : It is also a minimally
invasive procedure in which an opening is made in the pericardium to drain

7. fluid that has accumulated around the heart.This can be done by making a small
incision below the end of the sternum or in between the ribs on the left side of the
chest.
CARDIAC TAMPONADE
• It occurs due to the compression of the chambers of the heart due to PE.
• This prevents the ventricles to fully expand.
• The excess pressure from the fluid prevents the heart from functioning normally.
• As a result the body does not receive enough blood and also experience a dramatic
drop in BP which can be fatal.

8. ETIOLOGY
o Pericardial effusion
o Tuberculosis
o Trauma
o Neoplasm/malignancy
Uncommon causes
o Connective tissue diseases (SLE, RA, Scleroderma)
o Radiation induced
o Post MI
o Aortic dissection
o Bacterial infection
o Pneumonopericardium
SYMPTOMS
o Chest pain
o Dyspnea
o Dry cough
o Hoarseness
o Dysphagia
o Singultus ( Hiccups)
o Nausea
o Abdominal pain
o Hypotension

9. PATHOPHYSIOLOGY
Fluid within the pericardium puts pressure on the heart
The pressure prevents the heart from expanding completely
Less blood leaves the heart
Too little oxygen reaches the tissue
Loss of consciousness and sudden death

10. DIAGNOSIS
o Classical cardiac tamponade presents three major signs known as Beck’s
Triad
i. Hypotension : occurred because of decreased stroke volume.
ii. Jugular venous distension : due to impaired venous return to the heart.
iii. Muffled heart sounds : due to fluid inside pericardium.
o Pulsus paradoxus – A drop of at least 10 mmHg in systolic BP
o Hypotension

11. MANAGEMENT OF CARDIAC TAMPONADE
Goals of treatment
i. To relieve pressure on heart.
ii. To treat underlying disease.
iii. To stabilize the patient.
Treatment
The main goal is to drain the fluid accumulated in the pericardial cavity.
Methods to drain pericardial fluid include:
• Pericardiocentesis
• VATS
• Pericardial Window

12.  Bed rest with leg elevation :To reduce the hearts work load.
 Inotropic drugs, such as dobutamine :To improve heart function and lower
blood pressure.
 Oxygen :To reduce hearts workload.
 Medications that can reduce inflammation a/w PE:
o Aspirin
o NSAIDs: Indomethacin, Ibuprofen
o Colchicine
o Corticosteroids: Prednisone