CARDIAC TAMPONADE
Cardiac tamponade = life threatening condition caused by compression of the heart due to accumulation of blood, fluid,
clots or gas within the pericardial space, preventing adequate filling and contraction.
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Presentation
Causes Beck’s triad:
1. Hypotension
2. Venous distension (raised JVP)
3. Muffled heart sounds.
The presentation depends on speed of development of the tamponade.
§ Chest pain
§ Dyspnoea
§ Collapse
§ Fatigue
§ Peripheral oedema
§ Tachycardia
§ Pulsus paradoxus
§ Pericardial rub
§ Features of shock ® cool peripheries, peripheral cyanosis, reduced urine output.
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Pathophysiology
A cardiac tamponade occurs due to a pericardial effusion (excess fluid or other substance) within the pericardial space.
§ Normal pericardial sac contains 20-50 ml of pericardial fluid
§ Excess fluid may accumulate in the pericardial sac due to:
o Inflammation and increased fluid production
o Reduced reabsorption from increased venous pressure
o Haemorrhage into the sac
§ Can be classified according to four factors:
o Onset ® acute, subacute, chronic (>3 months)
o Size ® mild (<10 mm), moderate (10-20 mm), large (>20 mm)
o Distribution ® circumferential, loculated
o Composition ® transudate, exudate
§ Effusion can lead to ® increased pericardial pressure ® compression of all heart chambers
§ Acute accumulation of fluid ® rapid development of haemodynamic compromise
§ Common causes of tamponade:
o Pericarditis, TB, iatrogenic (e.g. post-invasive cardiac procedure), trauma, malignancy
§ Uncommon causes of tamponade:
o Connective tissue disease, radiation, uraemia, post-MI, aortic dissection, bacterial infection
§ The main issue in tamponade is compression of the heart chambers due to increased pericardial volume
o As pressure increases, chambers become smaller and there is decreased diastolic compliance
o Tamponade reduces venous return ® restricts ventricular filling ® reduced SV and CO
o End result = decrease in BP and haemodynamic compromise
§ Pulsus paradoxus ® decrease in systolic arterial BP >10 mmHg during inspiration
o During inspiration, venous return normally increases to the right side of heart and pulmonary venous return
decreases to left side
o When heart is compressed, only the interventricular septum distends partially on inspiration
o Septum bulges into the left ventricle, further impeding ventricular filling
o Causes greater fall in BP.
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Investigation
This requires an urgent echocardiogram.
Echocardiogram
§ Features include:
o Chamber collapse ® early diastolic collapse of RV and late diastolic collapse of RA
Cardiac tamponade = life threatening condition caused by compression of the heart due to accumulation of blood, fluid,
clots or gas within the pericardial space, preventing adequate filling and contraction.
-----------------------------------------------------------------------------------------------------------------------------------------------------
Presentation
Causes Beck’s triad:
1. Hypotension
2. Venous distension (raised JVP)
3. Muffled heart sounds.
The presentation depends on speed of development of the tamponade.
§ Chest pain
§ Dyspnoea
§ Collapse
§ Fatigue
§ Peripheral oedema
§ Tachycardia
§ Pulsus paradoxus
§ Pericardial rub
§ Features of shock ® cool peripheries, peripheral cyanosis, reduced urine output.
-----------------------------------------------------------------------------------------------------------------------------------------------------
Pathophysiology
A cardiac tamponade occurs due to a pericardial effusion (excess fluid or other substance) within the pericardial space.
§ Normal pericardial sac contains 20-50 ml of pericardial fluid
§ Excess fluid may accumulate in the pericardial sac due to:
o Inflammation and increased fluid production
o Reduced reabsorption from increased venous pressure
o Haemorrhage into the sac
§ Can be classified according to four factors:
o Onset ® acute, subacute, chronic (>3 months)
o Size ® mild (<10 mm), moderate (10-20 mm), large (>20 mm)
o Distribution ® circumferential, loculated
o Composition ® transudate, exudate
§ Effusion can lead to ® increased pericardial pressure ® compression of all heart chambers
§ Acute accumulation of fluid ® rapid development of haemodynamic compromise
§ Common causes of tamponade:
o Pericarditis, TB, iatrogenic (e.g. post-invasive cardiac procedure), trauma, malignancy
§ Uncommon causes of tamponade:
o Connective tissue disease, radiation, uraemia, post-MI, aortic dissection, bacterial infection
§ The main issue in tamponade is compression of the heart chambers due to increased pericardial volume
o As pressure increases, chambers become smaller and there is decreased diastolic compliance
o Tamponade reduces venous return ® restricts ventricular filling ® reduced SV and CO
o End result = decrease in BP and haemodynamic compromise
§ Pulsus paradoxus ® decrease in systolic arterial BP >10 mmHg during inspiration
o During inspiration, venous return normally increases to the right side of heart and pulmonary venous return
decreases to left side
o When heart is compressed, only the interventricular septum distends partially on inspiration
o Septum bulges into the left ventricle, further impeding ventricular filling
o Causes greater fall in BP.
-----------------------------------------------------------------------------------------------------------------------------------------------------
Investigation
This requires an urgent echocardiogram.
Echocardiogram
§ Features include:
o Chamber collapse ® early diastolic collapse of RV and late diastolic collapse of RA
