Cardiac Tamponade

Cardiac Tamponade occurs when there is an excess accumulation of pericardial fluid in the pericardium.  Pericardial fluid compresses the heart, especially the ventricles, and consequently prevents the ventricles from filling or pumping blood fully.  As a result of this excess pressure exerted on the heart, diastolic pressures rise and diastolic filling is limited resulting in a decrease in cardiac output.  This condition causes a decrease in cardiac output despite countermechanisms such as peripheral vasoconstriction.  Cardiac tamponade could be caused by malignant disease, pericarditis, heart attack, tuberculosis, bacterial or viral infection, and lupus.

Symptoms of cardiac tamponade include tachycardia, hypotension, neck vein distension, cardiac output decrease, mediastinal drainage decreases, pulsus paradoxus (the paradoxical fall of blood pressure when a person inhales), narrow pulse pressure, increase pulmonary artery pressure, absent heart sounds, chest pain, cyanosis, and cold extremities.  Other symptoms include anxiety, restlessness, difficulty breathing, bent posture, rapid breathing, fainting, and lightheadedness.

The diagnosis of cardiac tamponade include the use of echocardiography. Furthermore, chest x-rays, coronary angiography, and ECG are also used as diagnostic tools for cardiac tamponade.  Here's an example of an echocardiogram:



The main complication arising from cardiac tamponade is the possibility of shock from hypotension due to decreased cardiac output.  Other complications include heart failure and pulmonary edema.  Treatment of cardiac tamponade include removal of excess fluid from the pericardial sac (pericardiocentesis) in emergency situations.  Analgesics and diuretics can be used to stabilize the patient.  Surgical pericardiectomy might be performed if scarring is a major cause of cardiac tamponade.

Sample Problems:

1. What is cardiac tamponade?
2. What are some symptoms of cardiac tamponade?
3. Name a diagnostic tool for diagnosing cardiac tamponade.
4. What are the complications from cardiac tamponade?
5. What is the first complication resulting from cardiac tamponade?
6. What is the name of the procedure used to remove excess pericardial fluid?
7. What is the name of the procedure used to remove scarring of the pericardium?
8. What is the cause of cardiac tamponade?

Answers:

1. Excess accumulation of pericardial fluid in the pericardium resulting in a compression of the ventricles.
2. Symptoms of cardiac tamponade include tachycardia, hypotension, neck vein distension, cardiac output decrease, mediastinal drainage decreases, pulsus paradoxus (the paradoxical fall of blood pressure when a person inhales), narrow pulse pressure, increase pulmonary artery pressure, absent heart sounds, chest pain, cyanosis, and cold extremities.  Other symptoms include anxiety, restlessness, difficulty breathing, bent posture, rapid breathing, fainting, and lightheadedness.
3. echocardiogram
4. shock from hypotension, heart failure, pulmonary edema
5. decrease in cardiac output
6. pericardiocentesis
7. pericardiectomy
8. Cardiac tamponade could be caused by malignant disease, pericarditis, heart attack, tuberculosis, bacterial or viral infection, and lupus.

For more information on this topic, please refer to Berne & Levy .

• http://www2.umdnj.edu/~shindler/pleural_effusion.html
• http://www.familyinternet.com/peds/scr/000194sc.htm
• http://www.nursing.ab.umd.edu/students/~mcsu/Cardtamp.htm
• http://www.merck.com/!!tlCOn34qztlCOn34qz/pubs/mmanual/html/qohmilhd.htm

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