CARDIAC

TAMPONADE

PERICARDIUM
Fibro serous sac
Inner visceral layer & outer parietal layer
10-50 ml of pericardial fluid
Drainage of pericardial fluid by rt. Lymphatic duct and
thoracic duct

DEFINITION
Compression of all cardiac chambers due to excessive
accumulation of pericardial fluid leading to
compromised cardiac output.
Clinical syndrome caused by accumulation of fluid in
pericardial space resulting in reduced ventricular filling
and subsequent hemodynamic compromise.

ETIOLOGY
Malignancy
Infection
Drugs hydralazine, procainamide, isoniazid, minoxidil
Postcoronary intervention (coronary dissection, perforation)
Trauma
Cardiovascular surgery
Post MI
Connective tissue disorders SLE, rheumatoid arthritis, dermatomyositis
Iatrogenic after sternal biopsy, pacemaker lead implantation,
pericardiocentesis, central line insertion
Uremia

PATHOPHYSIOLOGY
The outer pericardium is made of fibrous tissue which does not easily stretch
Fluid begins to enter the pericardial space
Pressure starts to increase
Less and less blood enters the ventricles
Increasing pressure presses on the heart and forces the septum to bend into
the LV
Decreased stroke volume
Obstructive shock

CLINICAL FEATURES
Dyspnea
Chest pain
Abdominal pain
Fatigue
Fever
Cough
Weakness
Palpitation
Features of shock

CLINICAL FEATURES - Becks

triad
Hypotension due to decreased stroke volume
Diminished/muffled heart sounds due to fluid inside
pericardium
Jugular venous distention due to impaired venous
return to heart

CLINICAL FEATURES
Hepatomegaly
Evidence of chest wall trauma
Pulsus paradoxsus a drop in inspiratory BP by greater
than 10 mm Hg
Kussmaul sign paradoxical increase in venous
distention & pressure during inspiration

DIAGNOSIS
History and physical examination
ECG low voltage, sinus tachy
Chest X ray water bottle shaped heart
Echocardiogram

MANAGEMENT
O2
Volume expansion with blood, plasma or saline to
maintain adequate intravascular volume
Bed rest with leg elevation to increase venous return
Inotropic drugs
Sub xiphoid percutaneous drainage
Pericardiocentesis

COMPLICATIONS
Pulmonary edema
Shock
Cardiac arrest
Death