Sunday, August 4, 2013

Cardiac Tamponade




WHAT WENT WRONG?

A large amount of liquid accumulates in the sack around the heart (pericardium),
creating pressure on the heart that reduces the filling of ventricles with blood. This
results in a low volume of blood being pumped with each contraction. The accumulating
pressure within the pericardium may be due to fluid, pus, or blood. The
end result is decreased stroke volume and cardiac output.
The cause of tamponade may be trauma, postoperative, post-MI, uremia, or
cancer. The fluid may develop rapidly or over time, depending on cause. Tamponade
is a life-threatening condition. The seriousness is related to the amount of pressure
within the heart and the resulting decrease in ventricular filling.

 PROGNOSIS

Cardiac tamponade is a medical emergency requiring immediate intervention, such
as drainage of the fluids. Stabilization occurs quickly once the fluid is removed and pressure is alleviated. If fluid recurs, surgery may be necessary. The prognosis depends
on the etiology of the tamponade.

HALLMARK SIGNS AND SYMPTOMS

Neck vein distention—accumulation of fluid within the pericardium causes
pressure on the heart, which prevents the venous return from the jugular
veins. This causes distention, more pronounced on inspiration.
Restlessness due to decreased oxygen to the brain.
Muffled (dull) heart sounds on auscultation because it’s harder to hear through
fluid.
Pulsus paradoxus—decrease of 10 mmHg or more in SBP during inspiration—
change in pressure within the chest during inspiration, resulting in
decreased ventricular filling, decreased output, fall in SBP.
Sweating (diaphoresis).
Difficulty breathing (dyspnea).
Tachycardia.
Hypotension.
Fatigue.

INTERPRETING TEST RESULTS

Echocardiograph: Ultrasound image of the heart to assess the heart’s position,
structure, and motion. Ventricle and atria are compressed. Fluid found
within pericardial sac.
Cardiac catheterization.
Chest x-ray shows an enlarged heart if large effusion present.
Electrocardiogram used to rule out other cardiac problems.

TREATMENT

Treatment is directed at reducing the pressure on the heart from the accumulating
fluids in the pericardial sac. The following may be necessary to support and stabilize
the patient.Pericardiocentesis: Aneedle is inserted into the pericardium and fluid is aspirated
or drained.
Administer adrenergic agent—increases heart rate and blood pressure.

DIAGNOSES

Anxiety
Ineffective tissue perfusion
Decreased cardiac output

INTERVENTION

Monitor vital signs.
Assure adequate oxygenation.



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