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Cardiac tamponade

Pericardial fluid accumulates, causing an increase in intrapericardial pressure, which prevents the heart from filling properly and ultimately stops its pumping function.

Pericardial fluid accumulates, causing an increase in intrapericardial pressure, which prevents the heart from filling properly and ultimately stops its pumping function.

Management

If BP unrecordable, call the cardiac arrest team.
  • Manage in Coronary Care Unit, or ICU.

Investigations

  • BP: reduced
  • JVP: increased
  • Muffled heart sounds
  • JVP: increased on inspiration
  • Pulsus paradoxus (pulse fades on inspiration)
  • Echo may be diagnostic
  • CXR:
    • Globular heart
    • Left heart border convex or straight
    • Right cardio-phrenic angle <90°.
  • ECG: electrical alternans

Treatment

  • Prompt pericardiocentesis brings swift relief.
  • Give O2 target arterial saturations of 94–98% (88–92% if COPD)
  • Monitor ECG
  • Blood group (ABO and Rh type)
    • Storing the blood sample so it can be cross-matched if a transfusion is required
  • Set up IVI
  • There may be a role for cardiothoracic surgery as a definitive solution to some causes.

Note!

Cardiogenic shock

This article specifically addresses items specific to cardiac tamponade management
For comprehensive management of cardiogenic shock, please refer to the cardiogenic shock article.

Burns

The rule of nines: (arm: 9%; front of trunk 18%; head and neck 9%; leg 18%; back of trunk 18%; perineum 1%).

Cardiogenic shock

Cardiogenic shock is a state of inadequate tissue perfusion primarily due to cardiac dysfunction. It may occur suddenly, or after progressively worsening heart failure.

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