Cardiovascular Medicine Book

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Cardiac Tamponade

Aka: Cardiac Tamponade, Pericardial Tamponade, Beck's Triad
  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. Classic presentation (Beck's Triad)
      1. Hypotension
      2. Narrow Pulse Pressure
      3. Quiet heart sounds
    2. Cardiac exam
      1. Distended neck veins (Jugular Venous Distention)
        1. Increased Central Venous Pressure (CVP)
      2. Hyperdynamic JVP waveform (exaggerated X descent)
      3. Pulsus Paradoxus (pathognomonic for Pericardial Effusion)
      4. Faint heart sounds
      5. Friction rub
    3. 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)
      1. Focused Assessment with Sonography for Trauma (FAST)
      2. See Pericardial Effusion for Echocardiogram findings
    2. Electrocardiogram
      1. Low voltage complexes
      2. Electrical alternans may be present
      3. Untreated, Pulseless Electrical Activity (PEA) may result
    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 diagnosis
  9. Differential Diagnosis: Shock states
    1. Myocardial Infarction
    2. Septic Shock
    3. Pulmonary Embolism
  10. Management: Emergent
    1. Immediate Pericardiocentesis under Ultrasound guidance (ATLS)
      1. See Emergency Pericardiocentesis
      2. Sub-xiphoid approach
      3. Needle angled toward left Shoulder
      4. Constant suction applied to syringe on entry
      5. Send fluid for cytology if not Traumatic in origin
    2. Emergency Thoracotomy
      1. Indicated in Cardiac Tamponade due to Trauma (esp penetrating), refractory to Pericardiocentesis
    3. Emergent Cardiothoracic surgery
      1. Pericardial window placement and other definitive management
    4. Intravenous Fluids
      1. Transient stabilization to increase venous pressure
    5. Precautions
      1. Avoid Positive Pressure Ventilation until after decompression with Pericardiocentesis
        1. Negative intrathoracic pressure is the last safeguard maintaining venous return in Pericardial Tamponade
        2. Positive Pressure Ventilation eliminates negative intrathoracic pressure
        3. Pulseless Electrical Activity arrest (PEA arrest) results
      2. Avoid measures that reduce cardiac filling
        1. Avoid inotropes (increased Heart Rate decreases filling time)
      3. References
        1. Mallemat and Swadron in Herbert (2013) EM:Rap 13(12): 10-11
  11. Management: Malignancy specific
    1. Consider reaccumulation prevention (post-stabilization)
      1. Chemotherapy
      2. Radiation
      3. Sclerosis

Cardiac Tamponade (C0007177)

Definition (MSHCZE) Komprese srdce nahromaděným výpotkem (PERIKARDIÁLNÍ EFÚZE) nebo krví (hemoperikard) v osrdečníku (PERIKARD). Srdeční výdej takto postiženého orgánu může dosahovat podob od minimálního až po celkový hemodynamický kolaps. (SRDCE – MINUTOVÝ OBJEM).
Definition (NCI_CDISC) Compression of the heart caused by increased intrapericardial pressure due to the collection of blood or fluid in the pericardial space. Cardiac tamponade should usually be documented by either: Echocardiogram showing pericardial fluid and signs of tamponade such as right heart compromise, or systemic hypotension due to pericardial fluid compromising cardiac function.
Definition (NCI_FDA) 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.
Definition (NCI_CTCAE) A disorder characterized by an increase in intrapericardial pressure due to the collection of blood or fluid in the pericardium.
Definition (CSP) compression of heart from pericardial effusion or hemopericardium.
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.
Concepts Disease or Syndrome (T047)
MSH D002305
ICD9 423.3
ICD10 I31.4
SnomedCT 266295005, 155341007, 194975004, 35304003
English Cardiac Tamponade, Cardiac Tamponades, Tamponade, Cardiac, Tamponades, Cardiac, heart tamponade, Tamponade, Pericardial, Pericardial Tamponade, Tamponades, Pericardial, Pericardial Tamponades, Rose's tamponade, cardiac tamponade, cardiac tamponade (diagnosis), Tamponade cardiac, Cardiac Tamponade [Disease/Finding], pericardial tamponade, tamponade cardiac, Tamponade, cardiac, CARDIAC TAMPONADE, Pericardial tamponade, Cardiac tamponade, Cardiac tamponade (disorder), tamponade; cardiac
Portuguese TAMPONAMENTO CARDIACO, Tamponamento pericárdico, Tamponamento Pericárdico, Compressão Pericárdica, Compressão Cardíaca, Tamponamento cardíaco, Tamponamento Cardíaco
German HERZTAMPONADE, Perikardtamponade, Herzbeuteltamponade, Herztamponade
Dutch pericardtamponade, tamponade; hart, harttamponade, Harttamponade, Tamponade, hart-
Spanish Taponamiento pericárdico, Taponamiento Pericárdico, Compresión Cardíaca, Compresión Pericárdica, taponamiento cardíaco (trastorno), taponamiento cardíaco, taponamiento pericárdico, Taponamiento cardiaco, Taponamiento Cardíaco
Swedish Hjärttamponad
Japanese シンマクタンポナーデ, シンタンポナーデ, 心臓タンポナーデ, 心タンポナーデ, 心膜タンポナーデ
Finnish Sydämen tamponaatio
French Tamponnade péricardique, Tamponnade, TAMPONNADE, Tamponnade cardiaque
Russian SERDTSA TAMPONADA, СЕРДЦА ТАМПОНАДА
Czech Perikardiální tamponáda, Srdeční tamponáda, Tamponáda srdeční, srdce - tamponáda, srdeční tamponáda
Italian Tamponamento pericardico, Tamponamento cardiaco
Polish Tamponada serca
Hungarian Szív tamponad, Pericardialis tamponad, Szívtamponad
Norwegian Hjertetamponade
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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