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.
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