Download Cardiac Tamponade

Learning Objectives
• Define cardiac tamponade.
Cardiac Tamponade
• Identify causes of cardiac tamponade.
• Enumerate signs and symptoms of disease.
• Explain how to diagnose the case.
• Discus the Principles of care.
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Cardiac Tamponade
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Cardiac Tamponade
Definition
• It is a result of accumulation of excess pericardial
fluid that compress the heart.
• Bleeding into the pericardial sac or small pericardial
rupture may or may not cause cardiac tamponade,
depending on the amount of pressure in the
• It is causing decreased cardiac filling, which leads to
reduced cardiac output and shock.
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pericardium.
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Cardiac Tamponade
Cardiac Tamponade
• The pericardial sac normally holds about 25 ml of
• Continued bleeding increases the pressure rapidly
fluid, which serves to cushion and protect the heart.
• Only a small amount of pericardial blood (50 to 100
ml)
is
necessary
to
increase
intrapericardial
and the patient present with signs of cardiac
tamponade.
pressure.
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Cardiac Tamponade
Cardiac Tamponade
Signs and Symptoms
5. Ankle or sacral edema;
1. Decreased blood pressure.
6. Ascites;
2. Abnormal heart sounds.
7. Hepatosplenomegaly.
8. Dyspnea, cough, and retrosternal pain that is relieved by
3. Increased central venous pressure.
leaning forward
4. Distended neck veins during inspiration
9. Epigastric pain, hiccups, hoarseness, nausea, and vomiting.
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Cardiac Tamponade
Cardiac Tamponade
Diagnostic Studies.
Patient care
• A chest film is used to determine the presence of cardiac enlargement,
1. Place the patient in Trendelenburg position, notify the physician.
mediastinal widening.
2. Administer oxygen as ordered.
• The electrocardiogram (ECG) may show nonspecific abnormalities,
including ST segment elevations, and T-wave changes.
3. Prepare the patient for Pericardiocentesis.
4. Emergency Pericardiocentesis is life saving.
• Echocardiography.
5. Removal of 50 to 100 ml of fluid can bring major hemodynamic
• Catheterization of the right side of the heart reveals pericardial
tamponade.
improvement.
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Cardiac Tamponade
Pericardiocentesis
Patient care
5. If a pericardial catheter is present, aspirate pericardial fluid,
per orders.
6. Give fluids to increase preload ( The amount of cardiac
• Pericardiocentesis is a procedure where fluid is
aspirated from the pericardium (the sac enveloping
the heart).
muscle fibres tension or stretch that existing at diastole, just
before ventricular contraction).
7. Discontinue agents that decrease preload ( diuretic, nitrates,
morphine)
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Position
Process
• The patient undergoing pericardiocentesis is
positioned supine with the head of the bed raised to
a 30- to 60-degree angle.
• This places the heart in proximity to the chest wall
for easier insertion of the needle into the pericardial
sac.
• Anatomically, the procedure is carried out under the
xiphisternum up and leftwards
• It is generally done under ultrasound guidance, to
minimize complications.
• There are two locations that pericardiocentesis can
be performed without puncturing the lungs.
• One location is through the 5th or 6th intercostal
space at the left sternal border at the cardiac notch
of the left lung.
• The other location is through the infrasternal angle.
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Indications
• Indications include cardiac tamponade, as well as the need to
analyze the fluid surrounding the heart.
• The removal of the excess fluid reverses this dangerous
process.
• Cardiac tamponade is a condition in which an accumulation of fluid
within the pericardium creates excessive pressure, which then
• Examples of the need for fluid analysis would be to
differentiate whether a fluid collection within the
prevents the heart from filling normally with blood.
• This can critically decrease the amount of blood that is pumped
pericardium is due to an infection, spread of cancer, or
possibly an autoimmunecondition.
from the heart, which can be lethal.
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