Cardiac Tamponade

Cardiac Tamponade

Cardiac tamponade is a life-threatening emergency caused by rapid or progressive accumulation of fluid in the pericardial space, leading to impaired diastolic filling of the heart, reduced cardiac output, and shock.

Pathophysiology: Pericardial fluid → ↑ intrapericardial pressure → ↓ diastolic filling → ↓ CO → obstructive shock

1. Etiology

1. Trauma (hemopericardium)
2. Malignancy
3. Uremia
4. Infection (TB, viral)
5. Post-MI free wall rupture
6. Autoimmune disease

2. Clinical Features

2.1 Beck’s Triad (classic):

1. Hypotension
2. Jugular venous distension (JVD)
3. Muffled (distant) heart sounds

2.2 Other features:

1. Tachycardia (most common compensatory response)
2. Dyspnea, tachypnea
3. Cool extremities (shock)
4. Clear lung fields (distinguishes from cardiogenic shock)

2.3 Key signs:

1. Pulsus paradoxus: ↓ systolic BP >10 mmHg during inspiration
2. Elevated JVP

3. Diagnosis

1. ECG: sinus tachycardia (most common), low-voltage QRS complexes, and ± electrical alternans.
2. Echocardiography (best test): pericardial effusion with right atrial systolic collapse, right ventricular diastolic collapse, and a dilated IVC.
3. Cardiac catheterization: equalization of diastolic pressures in all cardiac chambers, with elevated JVP, prominent x descent, and absent y descent.

4. Management

4.1 Immediate (unstable):

1. Pericardiocentesis (life-saving)

4.2 Temporizing:

1. IV fluids (↑ preload)
2. Oxygen
3. Avoid positive pressure ventilation

4.3 Definitive:

1. Surgical drainage (trauma, recurrent, loculated)

5. Clinical Pearls

👉 Hypotension + JVD + clear lungs → get STAT echo → pericardiocentesis