34 / 56
46
Chapter 2
•
Cardiovascular Care
CARDIAC TAMPONADE
Cardiac tamponade is a life-
threatening compression of the heart
due to the pericardial accumulation
of fluids as a result of inflammation,
infection, trauma, and rupture of the
heart or aortic dissection. Common
causes of cardiac tamponade include:
•
Viral pericarditis and effusion
•
Ascending aortic dissection
rupturing into the pericardium
•
LV free wall rupture after a large
anterior MI
•
Trauma
•
Neoplasm/malignancy
•
Iatrogenic (invasive procedure-
related, postcardiac surgery)
Uncommon causes of cardiac
tamponade:
•
Collagen vascular diseases
(systemic lupus erythematosus,
rheumatoid arthritis, scleroderma)
•
Radiation induced
•
Uremia
•
Bacterial infection
•
Tuberculosis
•
Pneumopericardium
Clinical Manifestations
•
Tachycardia
•
Hypotension
•
Pulsus paradoxus
•
Raised jugular venous pressure
•
Muffled heart sounds
•
Decreased electrocardiographic
voltage with electrical alternans
•
Enlarged cardiac silhouette on
chest x-ray
•
Pain in anterior chest, worsened
by motion, may vary from mild to
sharp and severe chest. Generally
located in precordial area and may
be relieved by leaning forward
Treatment
•
Removal of the pericardial fluid
(pericardiocentesis)
PICTURING
PATHO
Effects of Respiration and Cardiac Tamponade
on Ventricular Filling and Cardiac Output
Pericardium
Left
ventricle
Normal
expiration
Normal
inspiration
Tamponade
(in inspiration)
Effects of respiration and cardiac tamponade on ventricular filling and cardiac output.
During inspiration, venous flow into the right heart increases, causing the interventricular
septum to bulge into the left ventricle. This produces a decrease in left ventricular volume,
with a subsequent decrease in stroke volume output. In cardiac tamponade, the fluid in the
pericardial sac produces further compression of the left ventricle, causing an exaggeration
of the normal inspiratory decrease in stroke volume and systolic blood pressure. (Reprinted
with permission from Porth C.
Essentials of Pathophysiology
. 4th ed. Philadelphia: Wolters
Kluwer; 2015.)
TIP:
Abnormally large de-
crease in systolic blood
pressure (
>
10 mm Hg) on
inspiration is a common
finding in moderate to se-
vere cardiac tamponade.