Approach to patient with Cardiac tamponade

Cardiac tamponade is the result of compression of the myocardium by fluid, gas, pus, blood, or a combination of substances. It occurs in a physiologic continuum reflecting the amount of fluid, the rate of accumulation, and the nature of the heart.

The result is increased pericardial pressure, which causes decreased ventricle compliance and decreased flow of blood into the right ventricle which eventually leads to a decreased cardiac output.

Conditions that may predispose a patient to pericardial effusion and tamponade include; trauma, radiation exposure, Tb pericarditis, renal failure (uremic pericarditis), autoimmune diseases, drugs that induce a lupus-like syndrome, hypothyroidism, or ovarian hyperstimulation syndrome.

Clinical presentations

• Chest pain and dyspnea

• Pulsus paradoxus >10 mm Hg

• Beck’s triad includes low blood pressure, elevated jugular venous distention, and decreased heart sounds

• In the absence of hypotension and tension pneumothorax in a patient with PEA, consider the diagnosis of cardiac tamponade

Investigations

• Bedside ultrasound

• POC ECG

• Blood gases

• Serum Electrolytes

• Troponins

• Pericardial fluid analysis - biochemistry, microbiology and cytology

• Serum creatinine and urea

• Chest Xray

Non-pharmacological and pharmacological treatment

• Perform both primary and secondary assessment and provide appropriate interventions

• Give oxygen if hypoxic or increased work of breathing

• Connect the patient to a cardiac monitor and obtain vital signs

• Pericardiocentesis is the definitive management

Pharmacological treatment

A: 0.9% sodium chloride (IV): Adults 1-2 lts, Paediatrics 20ml/kg) to increase right sided filling pressure

Disposition

All patients with cardiac tamponade require inpatient management in an intensive care unit setting/HDU.