Introduction

Cardiac Tamponade is a condition where the heart become compressed by excess fluid in the pericardium. Compression causes reduced diastolic filling of the heart, which can cause cardiac arrest.

The pericardiac sac is normally a virtual space. This is enclosed by the pericardium.

Pericardium and Cardiac Tamponade

The Normal pericardial sac – size exaggerated in this diagram. Original image from Wikimedia commons. Author: Connexions

Causes of Cardiac Tamponade

  • Traumatic injury – particularly penetrating injury – can lead to accumulation of blood in the pericardial sac. This compresses the heart, and prevents diastolic filling, which leads to cardiac arrest. Cardiac Tamponade in a trauma setting an emergency and can quickly become life-threatening.
  • Pericarditis
  • Cancer
  • Iatrogenic – can occur after cardiothoracic surgery

Presentation

  • Becks Triad – occurs in about 1/3 of patients with cardiac tamponade
    • Hypotension
    • Distended Neck Veins
    • Muffled Heart Sounds
  • Tachycardia
  • Shortness of breath
  • Chest pain
  • Pulsus Paradoxus – systolic BP decreases >10mmHg on inspiration
  • Have a high index of suspicion in any patient with penetrating chest injury – especially they are not responsive to IV fluids and other basic investigations
  • FAST / bedside echo can diagnose without the need for other imaging (which may be time consuming)
  • It quickly causes cardiac arrest!

Management

  • Pericardiocentesis can be performed in the emergency setting in the peri-arrest scenario
    • Use a long 14 or 16G cannula attached a syringe
    • Insert at the angle of the xiphisternum and the left rib border – and aim for the ipsilateral (same side) scapula. Aspirate as you slowly advance. In reality this would often be performed US guided in the emergency department
    • Pericardiocentesis is sometimes attempted for suspected cardiac tamponade in the pre-hospital setting – but is rarely successful
  • Surgery may be indicated in some patients – this may be the formation of a pericardial window or could involve a pericardiectomy
  • Conservative management – may be attempted in some patients – albeit under very close monitoring (e.g. in the intensive care setting in a trauma patient)
  • Involving the cardiothoracics team (and trauma team if indicated) early in management and decision making is imperative

Related Articles