CARDIAC TAMPONADE

Dr. Mansoor KhanMBBS, FCPS I,

Resident, Surgical “C”, KTHPeshawar.

Jan 5th, 2009

“Compression of all cardiac chambers due to excessive accumulation of

pericardial fluid leading to

compromised cardiac out put”

Pericardium typically has 20-50 ml of fluid

Causes of Pericardial Tamponade

• Malignancy• Infection - Viral, bacterial (tuberculosis), fungal• Drugs - Hydralazine, procainamide, isoniazid, minoxidil• Postcoronary intervention (ie, coronary dissection and perforation)• Trauma• Cardiovascular surgery (postoperative pericarditis)• Postmyocardial infarction (free wall ventricular rupture, Dressler

syndrome)• Connective tissue diseases - Systemic lupus erythematosus,

rheumatoid arthritis, dermatomyositis• Iatrogenic - After sternal biopsy, transvenous pacemaker lead

implantation, pericardiocentesis, or central line insertion• Uremia

Pericardial fluid > increase intrapericardial pressure

Intrapericardial pressure equalizes RV diastolic Pressure

Then equalizes LV diastoilic pressureDrop in cardiac output

Pathophysiology

Dyspnea, Chest pain, Abdominal pain, Fatigue, Fever, Cough, Weakness,

Palpitation, Maybe in shock, thus not able to elicit

symptoms

S

YMPTOMS

Hypotension

JVPDiminished

heart sounds

Beck’s TriadS

I

G

N

S

HepatomegalyEvidence of chest wall trauma

Pulsus paradoxsus > 12 mm HgKussmaul sign - paradoxical

increase in venous distention and pressure during inspiration

S

I

G

N

S

low voltage, sinus tach, PR depression, electrical alternans

E

K

G

Enlarge cardiac silhouette, water bottle shaped heart

C

X

R

Pericardial effusion, collapse of the right ventricular, Swinging of the heart in its sac

ECHOCARDIOGRAM

In tamponade, near equalization (within 5 mm Hg) of the right

atrial, right ventricular diastolic, pulmonary arterial diastolic, and

pulmonary capillary wedge pressure

What to do while your waiting on CT Surgery…

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)

TREATMENT

A 16- or 18-gauge needle, angle of 30-45° to the skin, near the left xiphocostal angle, aiming towards the left shoulder

Mortality rate of approximately 4%, complication rate of 17%

Emergency subxiphoid percutaneous drainage

THANKS