Cardiac tamponade is caused by fluid accumulating in the pericardial space, putting pressure on the heart and reducing ventricular filling. Common causes include malignant diseases, infections like tuberculosis, and recent cardiovascular procedures. Symptoms include dyspnea, tachycardia, and muffled heart sounds. Diagnosis is made through echocardiogram showing pericardial effusion and ventricular collapse. Treatment involves pericardiocentesis to drain fluid followed by surgery to address the underlying cause and prevent reaccumulation. Complications can include cardiogenic shock if not treated promptly.

1. CARDIAC TAMPONADE
Prepared By:
Sharmin Susiwala

2. INTRODUCTION
“Cardiac tamponade, also known as pericardial tamponade, is an
acute type of pericardial effusion in which fluid accumulates in the
pericardium leads to pressure on the heart muscle which
occurs when the pericardial space fills up with fluid faster than the
pericardial sac can stretch.”
 Cardiac tamponade is a clinical syndrome caused by the
accumulation of fluid in the pericardial space, resulting in reduced
ventricular filling and subsequent hemodynamic compromise.
 The condition is a medical emergency

3. ETIOLOGY
 For all patients, malignant diseases are the most common cause of
pericardial tamponade
Malignant diseases - 30-60% of cases
 Tamponade can occur as a result of any type of pericarditis.
Pericarditis can result from the following:
Human immunodeficiency virus (HIV) infection
 Infection - Viral, bacterial (tuberculosis), fungal

4.  Other causes are:
Trauma to the chest(either penetrating trauma involving the
pericardium or blunt chest trauma)
Drugs - Hydralazine, procainamide, isoniazid, minoxidil
Postcoronary intervention - Ie, coronary dissection and perforation
Acupuncture
Postcardiac percutaneous procedures –
- Including mitral valvuloplasty
- atrial septal defect (ASD) closure
- left atrial appendage occlusion

5.  Cardiovascular surgery - Postoperative pericarditis
 Postmyocardial infarction - Free wall ventricular rupture, Dressler
syndrome
 Connective tissue diseases - Systemic lupus erythematosus,
rheumatoid arthritis, dermatomyositis
 Radiation therapy to the chest
 Iatrogenic –
- After sternal biopsy
- transvenous pacemaker lead implantation
- pericardiocentesis
- central line insertion
- In first 24 to 48 hours after heart surgery. After heart surgery, chest
tubes are placed to drain blood. These chest tubes, however, are
prone to clot formation. When a chest tube becomes occluded or
clogged, the blood that should be drained can accumulate around
the heart, leading to tamponade.

6.  Anticoagulation treatment
 Idiopathic pericarditis
 Complication of surgery at the esophagogastric junction - Eg,
antireflux surgery
 Pneumopericardium - Due to mechanical ventilation or
gastropericardial fistula
 Hypothyroidism
 Still disease
 Duchenne muscular dystrophy
 Type A aortic dissection

7. PATHOPHYSIOLOGY
 The outer layer of the heart is made of fibrous tissue which
does not easily stretch, and so once fluid begins to enter
the pericardial space, pressure starts to increase.
 If fluid continues to accumulate, then with each successive
diastolic period less and less blood enters the
ventricles the increasing pressure presses on the
heart and forces the septum to bend into the left ventricle
leading to decreased stroke volume
 This causes obstructive shock to develop, and if left
untreated then cardiac arrest may occur

8. SYMPTOMS
 Dyspnea,Tachycardia,Tachypnea
 Dizziness, drowsiness, or palpitations
 Cold, clammy extremities
 H/0 Malignancy – weight loss, fatigue, anorexia
 Chest pain – pericarditis, MI
 MS pain – Fever , connective tissue disorder
 Renal failure – uremia
 Medications – drug related lupus
 Recent cardiovascular surgery, coronary intervention, or
trauma
 Recent procedure – pacemaker, central line
 TB – night sweats, fever
 Radiation – cancer history

9. PHYSICAL EXAMINATION
 Beck triad
 Described in 1935, this complex of physical findings,
also called the acute compression triad.
 Refers to increased jugular venous pressure,
hypotension, and diminished heart sounds.
 These findings result from a rapid accumulation of
pericardial fluid.
 This classic triad is usually observed in patients with
acute cardiac tamponade.

10.  Tachycardia
 Distant or muffled heart sounds
 Hepatomegaly
 Evidence of chest wall trauma
 Pulsus paradoxsus > 12 mm Hg
 Pulsus paradoxus (or paradoxical pulse) is an exaggeration (>12
mm Hg or 9%) of the normal inspiratory decrease in systemic
blood pressure.
 Kussmaul sign - paradoxical increase in venous distention and
pressure during inspiration
 Abolished y descent

11. DIAGNOSIS
 Chest radiography
 Chest radiography findings may show cardiomegaly, a water
bottle–shaped heart, pericardial calcifications, or evidence of
chest wall trauma.

12.  CT scanning
 Reveals compression of the coronary sinus an earlier marker for cardiac
tamponade in 46% of patients.
 Echocardiogram (diagnostic test of choice)
 Pericardial effusion
 Early diastolic collapse of the right ventricular free wall
 Late diastolic compression/collapse of the right atrium
 Swinging of the heart in its sac
 LV pseudohypertrophy

14.  ECG
 ST segment changes on the ECG which may also show low voltage QRS
complexes
 Sinus tachycardia, PR depression,

15.  Pulse Oximetry
 Respiratory variability in pulse-oximetry waveform is noted
in patients with pulsus paradoxus.
 Lab Studies

16. TREATMENT
 Pre-hospital care
 Initial treatment given will usually be supportive in nature.
 Oxygen
 Volume expansion with blood, plasma, or saline to
maintain adequate intravascular volume
 Bed rest with leg elevation
- This may help increase venous return.
 Inotropic drugs (i.e. dobutamine)
- Choose inotropes that do not increase systemic vascular
resistance while increasing cardiac output.

17. Hospital management
• Initial management in hospital is by
pericardiocentesis.
• This involves the insertion of a needle
through the skin and into the pericardium and
aspirating fluid under ultrasound guidance
preferably.
• This can be done laterally through the
intercostal spaces, usually the fifth, or as a
subxiphoid approach.
• Often, a cannula is left in place during
resuscitation following initial drainage so that
the procedure can be performed again if the
need arises.
• If facilities are available, an emergency
pericardial window may be performed
instead, during which the pericardium is cut
open to allow fluid to drain.
• Following stabilization of the patient, surgery
is provided to seal the source of the bleed
and mend the pericardium.

18. COMPLICATIONS
 Cardiogenic shock
 AMI
 Arrhythmia
 Heart failure
 Aneurysm
 Carditis
 Embolism
 Rupture