CARDIAC TAMPONADE

GROUP 6
 Introduction
 Cardiac tamponade is compression of the heart resulting from fluid or blood within the pericardial
sac.
 Cardiac tamponade puts pressure on the heart and keeps it from filling properly.
 This results to a dramatic drop in blood pressure that is fatal.
Aetiology
 It usually is caused by blunt or penetrating trauma to the chest.
 Cardiac tamponade also may follow diagnostic cardiac catheterization, angiographic procedures,
and pacemaker insertion, which can produce perforations of the heart and great vessels.
 Pericardial effusion with fluid compressing the heart also may develop from metastases to the
pericardium from malignant tumours of the breast, lung, or mediastinum and may occur with
lymphomas and leukemias, renal failure, TB, and high-dose radiation to the chest.
Pathophysiology.

Pericardial effusion (accumulation of fluid in the pericardial sac) may accompany advanced heart
failure, pericarditis, metastatic carcinoma, cardiac surgery, or trauma.
 Normally, the pericardial sac contains about 20 mL of fluid, which is needed to decrease friction for
the beating heart. An increase in pericardial fluid raises the pressure within the pericardial sac and
compresses the heart. This has the following effects:
 Elevated pressure in all cardiac chambers
 Decreased venous return due to atrial compression
 Inability of the ventricles to distend and fill adequately
Pericardial fluid may accumulate slowly without causing noticeable symptoms until a large amount
accumulates. However, a rapidly developing effusion can stretch the pericardium to its maximum size
and, because of increased pericardial pressure, reduce venous return to the heart and decrease CO. The
result is cardiac tamponade i.e compression of the heart
 Clinical Manifestations


Patient reports a feeling of fullness within the chest or may have pain. The feeling of pressure in the chest may result
from stretching of the pericardial sac.
 Venous pressure tends to increase because of increased pressure within the pericardium, as evidenced by engorged
neck veins.
 Shortness of breath
 Low blood pressure. Systolic blood pressure that is markedly lower during inhalation is called pulsus paradoxus (an
abnormal difference of at least 10 mm Hg in systolic pressure between the point that it is heard during exhalation and the
point that it is heard during inhalation).
 Cyanosis
 Heart palpitations
 Anxiety and restlessness
 The cardinal signs of cardiac tamponade are falling systolic blood pressure, narrowing pulse pressure, rising venous
pressure (increased JVD), and distant (muffled) heart sounds
 Assessment and Diagnostic Findings
 History and physical exam to identify the signs and symptoms
Imaging studies
 An echocardiogram is performed to confirm the diagnosis and quantify the amount of pericardial fluid.
 A chest x-ray may also show a large pericardial effusion.
 Lab tests; Blood tests to assess for signs of inflammation or infection
 Management

Thoracotomy for penetrating cardiac injuries
 Pericardiocentesis
If cardiac function becomes seriously impaired, pericardiocentesis is performed to remove fluid from
the pericardial sac.
 During this procedure, the patient is monitored by continuous ECG and frequent vital signs.
Emergency resuscitation equipment should be readily available.
 The head of the bed is elevated to 45 to 60 degrees, placing the heart in proximity to the chest wall so
that the needle can be directly inserted into the pericardial sac.
 If a peripheral IV line is not already in place, one is inserted, and a slow IV infusion is started in case
it becomes necessary to administer emergency medications or blood products.
 The pericardial aspiration needle is attached to a 50-mL syringe by a three-way stopcock. Several
possible sites are used for pericardial aspiration.
 Ctd:
 Typically, ultrasound imaging is used to guide placement of the needle into the pericardial space.
 The needle is advanced slowly until it has entered the pericardium and fluid is obtained.
 A resulting decrease in central venous pressure and an associated increase in blood pressure after
withdrawal of pericardial fluid indicate that the cardiac tamponade has been relieved.
 The patient almost always feels immediate relief. If there is a substantial amount of pericardial fluid,
a small catheter may be left in place to drain recurrent accumulation of blood or fluid.
 Pericardial fluid is sent to the laboratory for examination for tumour cells, bacterial culture, chemical
and serologic analysis, and differential blood cell count.
 NURSING MANAGEMENT AFTER
PERICARDIOCENTESIS

 After pericardiocentesis, the patient’s heart rhythm, blood pressure, venous pressure, and
heart sounds are monitored to detect possible recurrence of cardiac tamponade. If it recurs,
repeated aspiration is necessary.
 Respiratory assessment-assess lung sounds for any sign of pulmonary complications.
 Monitor input and output and assess for signs of fluid overload or depletion.
 Administer prescribed analgesics to manage pain or discomfort at the pericardiocentesis site.
 Keep the head of the bed elevated to promote respiratory function.
 Offer psychosocial support by addressing any concerns or anxiety related to the procedure.

Complications of pericardiocentesis
 They include: coronary artery puncture, myocardial trauma, dysrhythmias, pleural
laceration, and gastric puncture.
 Pericardietomy
 Recurrent pericardial effusions, usually associated with neoplastic disease, may be treated by a
pericardietomy (pericardial window).
 Under general anaesthesia, a portion of the pericardium is excised to permit the exudative pericardial
fluid to drain into the lymphatic system.

NURSING MANAGEMENT
 Vital signs monitoring to assess for improved cardiac function
 ECG monitoring to monitor changes in the cardiac rhythm
 Analgesics to manage pain post operatively.
 Wound care-keep the surgical site clean and dry
 Monitor input and output
 Encourage early ambulation to prevent complications related to immobility.
 Nutritional support
 Offer psychosocial support
 Offer health education to the patient and family.
 COMPLICATIONS OF CARDIAC TAMPONADE
 Cardiogenic shock
 Pulmonary edema
 Myocardial infarction or ischemia due to reduced coronary blood flow
 Arrhythmias
 Renal impairment due to reduced blood flow
 Cerebral hypoperfusion due to inadequate blood supply which can cause confusion, altered mental
status.