Cardiac tamponade

Cardiac tamponade is a medical emergency condition characterized by excessive accumulation of fluids in the pericardial space restricting the filling of cardiac chambers and subsequent low cardiac output and shock.

Clinical features:-

1. Beck’s triad:- Muffled heart sounds, jugular venous distension and hypotension.

2. Reflex tachycardia, cool extremities, tachypnea with clear lungs.

3. Pulsus paradoxus (i.e. decreased SBP >10 mmHg during inspiration).

Diagnosis:-

1. ECG shows electrical alternans, low voltage QRS complexes.

2. Chest x-ray shows enlarged cardiac silhouette (i.e. water bottle sign).

3. Echocardiography shows pericardial effusion,diastolic collapse of the right atrium and right ventricle, plethoric inferior venacava and impaired filling.

4. Cardiac catheterization shows elevation and equalization of intra pericardial and diastolic pressures in all chambers of the heart; shows elevated JVP with loss of the x descent.

Treatment:- Immediate pericardiocentesis.