From the Guidelines
Cardiac tamponade is a life-threatening condition characterized by the compression of the heart due to the accumulation of fluid, pus, blood, clots, or gas in the pericardial sac, requiring immediate drainage and treatment to prevent morbidity and mortality. According to the 2015 ESC guidelines for the diagnosis and management of pericardial diseases 1, cardiac tamponade can occur due to various causes, including inflammation, trauma, rupture of the heart, or aortic dissection. The clinical signs of cardiac tamponade include tachycardia, hypotension, pulsus paradoxus, raised jugular venous pressure, muffled heart sounds, and decreased electrocardiographic voltage with electrical alternans.
Key Diagnostic Findings
- Pulsus paradoxus, defined as an inspiratory decrease in systolic arterial pressure of >10 mmHg during normal breathing, is a key diagnostic finding in cardiac tamponade 1
- Echocardiography is the single most useful diagnostic tool to identify pericardial effusion and estimate its size, location, and degree of hemodynamic impact 1
- Signs of tamponade can be identified by echocardiography, including swinging of the heart, early diastolic collapse of the right ventricle, and late diastolic collapse of the right atrium
Treatment
- The treatment of cardiac tamponade involves drainage of the pericardial fluid, preferably by needle pericardiocentesis, with the use of echocardiographic or fluoroscopic guidance 1
- Immediate drainage is necessary in patients with hemodynamic instability, and supportive measures include intravenous fluids, supplemental oxygen, and sometimes vasopressors
- The underlying cause of cardiac tamponade must be identified and treated, whether it's infection, malignancy, trauma, or autoimmune disease
Pathophysiology
- Cardiac tamponade occurs because the pericardium has limited ability to stretch, and when fluid accumulates rapidly, even small amounts can cause significant compression 1
- The stiffness of the pericardium determines fluid increments precipitating tamponade, and the magnitude of clinical and hemodynamic abnormalities depends on the rate of accumulation and amount of pericardial contents 1
From the Research
Definition and Causes of Cardiac Tamponade
- Cardiac tamponade is a cardiological emergency requiring prompt treatment to avoid a fatal outcome 2
- It is caused by the progressive accumulation of pericardial fluid, blood, pus, or air in the pericardium, compressing the heart chambers and leading to haemodynamic compromise, circulatory shock, cardiac arrest, and death 3
- Pericardial diseases of any aetiology, as well as complications of interventional and surgical procedures or chest trauma, can cause cardiac tamponade 3
Clinical Findings and Diagnosis
- Key clinical findings in patients with cardiac tamponade include hypotension, increased jugular venous pressure, and distant heart sounds (Beck triad) 3
- Dyspnoea can progress to orthopnoea, accompanied by weakness, fatigue, tachycardia, and oliguria 3
- Cardiac tamponade is a clinical diagnosis that can be confirmed using various imaging modalities, principally echocardiography 3
Treatment and Management
- Cardiac tamponade is preferably resolved by echocardiography-guided pericardiocentesis 3
- Percutaneous catheter pericardiocentesis is a recommended treatment option, with a success rate of 90-100% and rare major complications 2
- Surgical management is indicated in patients with aortic dissection, chest trauma, bleeding, or purulent infection that cannot be controlled percutaneously 3
- After pericardiocentesis or pericardiotomy, NSAIDs and colchicine can be considered to prevent recurrence and effusive-constrictive pericarditis 3