Cardiovascular Medicine Book

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Cardiac Tamponade

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  1. Definitions
    1. Compression of heart by fluid in pericardial sac
  2. Pathophysiology
    1. Physiologic effects of effusion vary by timing
      1. Gradual accumulation is accomodated by sack stretch (up to 250 ml)
      2. Rapid accumulation results in compromise
    2. Cardiac Tamponade pathway
      1. Effusion prevents diastolic relaxation of ventricles
      2. Right ventricular filling pressure approaches left ventricular pressure
        1. Loss of normal pressure differentials prevents diastolic filling of heart
  3. Causes
    1. See Pericardial Effusion
  4. Symptoms
    1. Common
      1. Dyspnea
      2. Fatigue
    2. Other symptoms
      1. Orthopnea
      2. Chest Pain
      3. Syncope
  5. Signs
    1. Cardiac exam
      1. Distended neck veins (Jugular Venous Distention)
      2. Hyperdynamic JVP waveform (exaggerated X descent)
      3. Pulsus Paradoxus
      4. Faint heart sounds
      5. Friction rub
    2. Cardiopulmonary Shock
      1. Kussmaul's Sign
      2. Cold clammy skin
      3. Tachycardia
      4. Falling arterial pressure
        1. Narrow Pulse Pressure
        2. Hypotension
      5. Cyanosis
  6. Imaging: Chest XRay
    1. Enlarged cardiac shadow: Globular appearance
  7. Diagnostics
    1. Echocardiogram (preferred study)
    2. Electrocardiogram
      1. Low voltage complexes
      2. Electrical alternans may be present
    3. Cardiac catheterization: Right-Left pressures equal
      1. Right ventricular diastolic pressure
      2. Pulmonary capillary wedge pressure
  8. Diagnosis
    1. Pulsus Paradoxus with Pericardial Effusion confirms
  9. Differential Diagnosis: Shock states
    1. Myocardial Infarction
    2. Septic shock
    3. Pulmonary Embolism
  10. Management: Emergent
    1. Immediate pericardiocentesis
      1. Sub-xiphoid approach
      2. Needle angled toward left shoulder
      3. Constant suction applied to syringe on entry
      4. Send fluid for cytology
    2. Cardiothoracic surgery with pericardial window placed
  11. Management: Malignancy specific
    1. Consider reaccumulation prevention (post-stabilization)
      1. Chemotherapy
      2. Radiation
      3. Sclerosis

Cardiac Tamponade (C0007177)

Definition (MSH)Compression of the heart by accumulated fluid (PERICARDIAL EFFUSION) or blood (HEMOPERICARDIUM) in the PERICARDIUM surrounding the heart. The affected cardiac functions and CARDIAC OUTPUT can range from minimal to total hemodynamic collapse.
Definition (CSP)compression of heart from pericardial effusion or hemopericardium.
Definition (NCI)Acute compression of the heart caused by increased intrapericardial pressure due to the collection of blood or fluid in the pericardium from rupture of the heart, penetrating trauma, or progressive effusion.
Definition (NCI)Acute compression of the heart caused by increased intrapericardial pressure due to the collection of blood or fluid in the pericardium from rupture of the heart, penetrating trauma, or progressive effusion.
ConceptsDisease or Syndrome (T047)
ICD9423.3
EnglishCARDIAC TAMPONADE, Cardiac Tamponades, heart tamponade, Pericardial Tamponade, Pericardial Tamponades, Rose's tamponade, TAMPONADE CARDIAC
Spanishtaponamiento cardíaco, taponamiento cardiaco, taponamiento pericárdico, taponamiento pericardico
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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