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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