Urgent considerations

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Cardiac tamponade

Cardiac tamponade occurs when pericardial pressure increases and limits cardiac filling.

The clinical presentation and the hemodynamic effect of cardiac tamponade depend on the size of the pericardial effusion, the time over which the fluid accumulated, and the clinical circumstances. It encompasses a hemodynamic spectrum from trivial compression with minimal effects on cardiac output to fatal cardiovascular collapse.

When pericardial fluid accumulates rapidly, impaired cardiac filling quickly progresses to cardiogenic shock followed by pulseless electrical activity. Causes of acute tamponade include chest trauma, chamber perforation during transcutaneous cardiac procedure, or type A aortic dissection. Symptoms include dyspnea and chest pain.

Examination findings suggestive of cardiac tamponade include:[6]

  • Tachycardia

  • Tachypnea

  • Hypotension

  • Elevated jugular venous pressure

  • Distended neck veins

  • Kussmaul sign (a rise in venous pressure with inspiration)

  • Pulsus paradoxus.

ECG may show low QRS voltages and electrical alternans (alternating QRS amplitude in any lead, caused by the heart swinging in the pericardial sac).

Urgent echocardiography is indicated to establish the effusion size, location, and hemodynamic effect.[6]

The treatment of tamponade is emergency drainage of the pericardial fluid using needle pericardiocentesis. Pericardiocentesis is performed under echocardiographic guidance. Surgical drainage may be indicated in cases of hemopericardium due to trauma, type A aortic dissection, or ventricular free wall rupture following myocardial infarction.[57]

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