Cardiac tamponade is caused by fluid accumulation in the pericardial space, reducing heart filling and function. It requires urgent treatment to remove fluid via pericardiocentesis or surgery. Symptoms include low blood pressure, increased heart rate, and difficulty breathing due to restricted heart movement. A diagnosis is made through echocardiography identifying fluid and heart compression.

3.  Cardiac tamponade is a clinical syndrome caused by
accumulation of fluid in pericardial space, resulting
in reduced ventricular filling and subsequent
haemodynamic compromise.
 The condition is a medical emergency.

4.  Pericardium is composed of 2 layers
 Thicker outer fibrous layer is parietal
percardium
 Thinner inner serous layer is visceral
pericardium
 Pericardial space normally contains 20 -
50 ml of fluid

5.  Three phases of haemodynamic changes in
tamponade
 PHASE 1: Accumulation of pericardial fluid
impairs relaxation and filling of ventricles,
requiring a high filling pressure.
 Left and right ventricular filling pressures are
higher than the intrapericardial pressure.

6.  PHASE 2: Pericardial pressure increases
above the ventricular filling pressure
,resulting in reduced cardiac output.
 PHASE 3: Further decrease in cardiac
output occurs due to equilibration of
pericardial and left ventricular filling
pressures.

7.  Malignant diseases – most common cause
(30-60%)
 Uremia(10-15%)
 Idiopathic pericarditis(5-15%)
 Infectious diseases(5-10%)
 CTD (2-6%)
 Dressler or post pericardiotomy syndrome(1-
2%)

8.  Pericarditis caused by
 HIV
 Infections- viral, bacterial(TB),fungal
 Drugs- hydralazine, procainamide, INH, minoxidil
 Post coronary intervention- coronary dissection and
perforation
 Post cardiac percutaneous procedures
 Trauma to chest
 Cardiovascular surgery
 Post MI infarction- free wall ventricular rupture and dressler
syndrome
 CTD- SLE ,RA, Dermatomyositis

9.  Radiation therapy to chest
 Iatrogenic- pericardiocentesis, central line insertion,
sternal biopsy, TV pacemaker lead implantation
 Uremia
 Anticoagulants
 Pneumopericardium
 Hypothyroidism
 Still disease
 Aortic Dissection

10.  The signs and symptoms of cardiac tamponade all reflect a
low cardiac output.
 Restlessness
 Agitation
 Drowsiness
 Stupor
 Decreased urine output
 Dyspnea
 Chest discomfort
 Syncope or near syncope
 Weakness
 Anorexia

11.  Tachycardia
 Tachypnea
 Raised JVP
 Dimnished heart sounds Beck’s Triad
Hypotension
 Hepatomegaly
 Pericardial friction rub

12.  PULSUS PARADOXUS: It is an exaggeration
>12mmHg or 9% of the normal inspiratory
decrease in systemic blood pressure.
It can be observed in patients with other
conditions such as constrictive pericarditis,
asthma, COPD, pulmonary embolism and right
ventricular infarction with shock.

14.  KUSSMAUL SIGN: It is paradoxical increase
in jugular venous distention and pressure
during inspiration.
 EWART SIGN/PINS SIGN: It is described as
an area of dullnes with bronchial breath
sounds and bronchophony below the angle
of left scapula.
 Y DESCENT: It is abolished in jugular
venous or right atrial wave form.It is due to
increased intrapericardial pressure
preventing diastolic filling of ventricles.

15.  With a 12-lead ECG ,the following
findings may be found:
 Sinus tachycardia
 Low-voltage QRS complexes
 Electrical alternans - an electrocardiographic
phenomenon of alternation of QRS complex
usually in a 2:1 ratio. It is caused by movement of
heart in pericardial space.
 PR Segment depression

17.  CHEST XRAY: may show
 cardiomegaly ,
 water bottle shaped heart,
 pericardial calcification or
 evidence of chest wall trauma.

19. Compression of coronary sinus is
observerd through CT scanning
as an earlier marker for cardiac
tamponade in 46% of patients.

21.  Pericardial effusion
Size often correlates w/risk of tamponade but not always.
 Diastolic chambers collapse
 RV diastolic collapse in early diastole (low sensitivity,
high specificity)
 RA diastolic collapse in late diastole (very sensitive
,specificity 82% ).The longer the duration of diastolic
collapse, the more
specific it is for tamponade.
 LA collapse (present in ~ 25%, highly spec)
 Abnormal inspiratory increase of RV dimensions with
abnormal inspiratory decrease of LV dimensions.
 IVC dilated & fails to collapse with inspiration at least
50%.

30. Definitive treatment of cardiac tamponade is achieved by removal of the
pericardial fluid, thereby relieving the elevated intrapericardial pressure
and improving hemodynamic status.
• Oxygen
• Bed rest with leg elevation - This may help increase venous
return
• Inotropic drugs (eg, dobutamine) - These can be useful because
they increase cardiac output without increasing systemic vascular
resistance
• Volume expansion with blood, plasma, dextran, or isotonic
sodium chloride solution, as necessary, to maintain adequate
intravascular volume
• Pericardiocentesis:Most require urgent and emergent
pericardiocentesis.

31. › PERCUTANEOUS THERAPY:
 Pericardiocentesis allows the rapid drainage
of pericardial fluid.
 Advantages are that it can be performed
quickly, is less invasive than other drainage
methods, and requires minimal preparation.
 Complications include laceration of the heart,
coronary arteries, or lung
 Subxiphoid approach under echo guidance is
most common - minimizes risk & can assess
completeness of fluid removal.
 Apical Approach
 Can alternatively use Fluoroscopic guidance
 Pigtail catheter often left in place

32. › SURGICAL DRAINAGE (subxiphoid
pericardiectomy, pericardial window, and subtotal
pericardiectomy):
 May be best for loculated effusions, effusions
containing clots or fibrinous material, and/or
effusions that are borderline in size
 Allow creation of a pericardial window for recurrent
effusions
 Surgical drainage is associated with more pain, a
longer recovery time, and more periprocedural
morbidity.

36. Possible Complications:
 Heart failure
 Pulmonary edema
 Shock
 Death

37.  Cardiac tamponade is a medical emergency.
If the fluid or blood is not quickly removed
from the pericardium, death can occur
quickly.
 The outcome is often good if the condition is
treated promptly, but tamponade may come
back.

38.  Tension Pneumothorax
 Constrictive Pericarditis
 Cardiogenic Shock
 Pulmonary Embolism