Cardiac tamponade is a medical emergency caused by an accumulation of fluid in the pericardial space, which surrounds the heart. This increased fluid pressure restricts the heart's filling and reduces cardiac output. If untreated, cardiac tamponade is rapidly fatal. Diagnosis is made through physical exam findings, electrocardiogram, chest x-ray and echocardiogram. Pericardiocentesis, a procedure to drain the fluid via needle insertion, provides immediate relief and is lifesaving for cardiac tamponade. After the procedure, close monitoring is needed to watch for potential complications and recurrence of fluid buildup.

1. CARDIAC TAMPONADE
Mohammed Niyas
Group 4a
Dept. of Surgery
TSMU

3. PERICARDIUM - ANATOMY
• Resilient Fibro-serous sac – envelops heart and great vessels
•2 layers
•Inner visceral layer – Serous Pericardium
•Monolayer membrane of mesothelial cells, collagen &
elastin fibres.
•Over the heart, same as the Epicardium - contains the
epicardial coronary arteries and veins, autonomic
nerves, lymphatics, and a variable amount of adipose
tissue.
•Reflects over the great vessels - forms delicate inner
lining of Fibrous Pericardium

4. •Outer parietal layer – Fibrous Pericardium
•Acellular, mainly collagenous fibrous tissue, little elastin
fibrils.
•2 mm thick normally. Contains the epicardial coronary
arteries and veins, autonomic nerves, lymphatics, variable
amount of adipose tissue.
•The junctions between the visceral and parietal pericardium
lie along the great vessels - pericardial reflections -
continuous along the pulmonary veins and vena cavae
•Posterior to LA, midline cul-de-sac known as the Oblique
Sinus.
•Behind the great arteries, the Transverse Sinus forms a
tunnel-like passageway.

5. •Between these 2 layers lies the Pericardial Space – 10-50
ml of fluid - ultrafiltrate of the plasma.
•Intrapericardial
•All 4 Chambers except posterior part of LA
•Almost entire Ascending Aorta, Main Pulmonary Artery, all
4 Pulmonary Veins
•In case of TAPVC, PV confluence is intrapericardial
•Extrapericardial
•Right and Left Pulmonary Artery
•Ductus Arteriosus

6. • Only noncardiovascular
macrostructure
associated with the
pericardium - the
Phrenic Nerves,
enveloped by parietal
pericardium.
• Drainage of pericardial
fluid is via right
lymphatic duct and
thoracic duct.

7. DEFINITION
“clinical syndrome caused by accumulation of
fluid in the pericardial space,
resulting in reduced ventricular filling and
subsequent hemodynamic compromise”
CARDIAC TAMPONADE

8. ↑ pericardial
fluid
Pressure onrt
sideof heart
↓Venousreturn
Poolingofblood
inpulmonary
capillaries
↓Strokevolume,
↓Cardiac
output
CardiacArrest
Howmuch pericardial fluid is needed to impair diastolic filling ?
PATHO-PHYSIOLOGY

9. Pericardial Pressure-Volume Relation

10. ETIOLOGY: blood/ pus/serous
• Physical trauma
• Pericarditis (bact/TB/HIV)
• Myocardial rupture
• After heart surgery
• Aortic dissection
• Neoplastic
• Hypothyroidism

11. CLINICAL SYMPTOMS
• Breathlessness
• Chest pain,
• Abdominal
pain,
• Fatigue,
• Fever,
• Cough,
• Palpitation,
• Maybe in
shock

12. PHYSICAL EXAMINATION
• tachycardia,
• distant or muffled
heart sounds
• jugular vein
distension
• falling BP,
• paradoxical pulse
(a drop in
inspiratory BP by
greater than 10
mmHg).

13. Beck's triad.(rapid accumulation of pericardial fluid)
1. Hypotension occurs because of decreased stroke volume
2. jugular-venous distension due to impaired venous return to the heart
3. muffled heart sounds due to fluid inside the pericardium

14. • complete blood count (CBC)
• RFT,LFT
• PT,INR
• CKMB, TROP-T
• ANA assay,
• ESR
• Rh FACTOR
• HIV testing
• Mantouxtest
• Pericardial fluidC/S, AFB
INVESTIGATIONS

15. ECG • sinus tachy ,low voltage QRS complexes ,
• electrical alterans,

16. CXR: large, globular heart, enlarge cardiac silhouette,
water bottle shaped heart

17. ECHO: “diagnostic test of choice “

19. TREATMENT:
Cardiac tamponade is a medical emergency
Untreated, cardiac tamponade is rapidly and universally fatal
Prompt diagnosis and treatment is the key.
• O2
• Volume expansion
• Bed rest
• Inotropic drugs
• Positive-pressure mechanical ventilation should be
avoided
• Pericardiocentesis:
• A Swan-Ganz catheter can be left in place for continuous
monitoring of hemodynamics
• repeat ECHO and a repeat CXR within 24 hours.

20. APPROACH
1. Sub-xiphoid :
A. Echo guided
B. ECG guided
C. Blind
2. Para-sternal
PERICARDIOCENTESIS

24. AFTER CARE
1. Monitor vitals
2. Look out for complications
3. Repeat ECHO & CXR
4. If Pt still symptomatic then may require placement of
catheter in the pericardial space or surgical creation
of a pericardial window
PERICARDIOCENTESIS

25. COMPLICATIONS
1. Cardiac arrhythmia
2. Pneumothorax
3. Pleural effusion
4. Myocardial injury
5. Peritoneal injury
6. Liver/stomach injury
7. Internal mammary artery injury
8. Diaphragmatic injury

26. RECURRENT TAMPONADE
• Pericardial window
• Sclerosing the pericardium
• Pericardio-peritoneal shunt
• Pericardiectomy

27. summary
•Cardiac tamponade is a medical emergency, and if
untreated, its rapidly and universally fatal
•Prompt diagnosis and treatment is the key.
•Pericardiocentesis is a life saving procedure in
tamponade
•Monitor vitals after the procedure to look for
complications

28. References:
• www.escardio.org/static_file/Escardio/Guidelines/publications/PERIC
Aguidelines-pericardial-FT