Shannen Whiddon

 Cardiactamponade is a condition in which

cardiac filling is impeded by an external
force.
 Cardiac tamponade is pressure on the
heart that occurs when blood or fluid
builds up in the space between the heart
muscle (myocardium) and the outer
covering sac of the heart (pericardium).
This large collection of fluid raises the
pressure in the pericardial sac,
compresses the cardiac chambers, and
prevents blood from entering the heart.
(Osborn, Watson, Wraa, 2010)
 Phase 1
 The accumulation of pericardial fluid causes
increased stiffness of the ventricle.
 Phase 2
 The pericardial pressure increases above the
ventricular filling pressure, resulting in reduced
cardiac output
 Phase 3
 A further decrease in cardiac output occurs due
to equilibration of pericardial and LV filling
pressures
 The client with congestive heart failure
develops cardiac tamponade. Which of the
following signs and symptoms would the
nurse assess?
 A. Distant or muffled heart sounds
 B. Hypertension
 C. Bradycardia
 D. Increased urine output
 The client with congestive heart failure
develops cardiac tamponade. Which of the
following signs and symptoms would the
nurse assess?
 A. Distant or muffled heart sounds
 B. Hypertension
 C. Bradycardia
 D. Increased urine output
 Signs and symptoms
 Chest pain, difficulty breathing, weak or absent
peripheral pulses
 Pulsus paradoxus
 Abnormally large decrease in systolic blood pressure
during inspiration (>10mmHg)
 Beck’s triad (3 D’s)
 Distended jugular veins
 Distant/muffled heart sounds
 Decreased arterial pressure
 Risk factors
 Heart surgery
 Dissecting aortic aneurysm
 Acute MI
 Hypothyroidism
 Pericarditis
 Injury to the heart
 End-stage lung cancer
 Radiation therapy to the chest
 Prevalence of disease
 Incidence rate: 2 in 10,000 in the U.S. (National
Institute of Health, 2011).
 Approximately 2% of penetrating injuries are
reported to result in tamponade
 1 year mortality rate of 76.5% in patients whose
tamponade was caused by malignant disease
 13.3% mortality rate in patients without
malignant disease
 Male-to-female ratio of 7:3
 HPI
 A 63 year old woman faints after experiencing
the sudden onset of severe chest pain that
radiates to her back.
 PMH
 Hypertension
 Assessment
 HR is 110 bpm and BP is 90/50
 Jugular veins distended
 Pulsus paradoxus
 Which diagnostic test is best at detecting
cardiac tamponade?
 A. Chest X-ray
 B. Echocardiography
 C. Electrocardiogram (ECG)
 D. Pulmonary artery pressure monitoring
 Which diagnostic test is best at detecting
cardiac tamponade?
 A. Chest X-ray
 B. Echocardiography
 C. Electrocardiogram (ECG)
 D. Pulmonary artery pressure monitoring
 Echocardiogram
 Best diagnostic tool
 Chest X-Ray
 Only helpful if there is at least 200mL of fluid in
the pericardial sac
 ChestCT or MRI
 Coronary angiography
 ECG
 Pericardiocentesis
 Needle aspiration of blood or other fluid from
the pericardial sac
 Surgical pericardiectomy or pericardial
window
 Procedure to cut and remove part of the
pericardium
 Fluids
to maintain normal BP
 Oxygen to reduce the workload on the heart
 MUST TREAT THE CAUSE TO PREVENT
RECURRENCE
 The role of medication therapy in cardiac
tamponade is limited
 Occasionally dobutamine may be used to
increase cardiac output
 Only drugs that do not cause an increase in
systemic vascular resistance
 Often good if the condition is treated
promptly
 Often comes back after treatment
 This is a medical emergency and if left
untreated, the condition is rapidly and
universally fatal
Decreased cardiac output
R/T decreased preload
and afterload AEB weak or
absent peripheral pulses
 Osborn, K., Watson, A., & Wraa, C. (2010). Medical-Surgical
Nursing Preparation for Practice. Pearson Education.
 National Institute of Health (2012. May 14). Cardiac Tamponade.
Retrieved from
http://www.nlm.nih.gov/medlineplus/ency/article/000194.htm
 Ross, G. and De Jong, M. (Feb., 1999). Emergency!: Pericardial
Tamponade. The American Journal of Nursing. Retrieved from
JSTOR.
 The British Medical Journal (1972. May 06). Tamponade After
Acute Myocardial Infarction. Retrieved from JSTOR.
 Mayo Clinic Staff. (2011, April 29). Pericarditis. Retrieved from
http://www.mayoclinic.com/health/pericarditis/DS00505/DSECT
ION=complications
 http://www.youtube.com/watch?v=GhbK9id
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