From the Guidelines
Cardiac tamponade is a life-threatening emergency that requires immediate recognition and intervention, and as a nurse, you should prioritize urgent pericardiocentesis or cardiac surgery to treat cardiac tamponade, as recommended by the European Society of Cardiology (ESC) guidelines 1. As a nurse, you should know that cardiac tamponade occurs when fluid accumulates in the pericardial sac, compressing the heart and preventing proper filling, which leads to decreased cardiac output, and this condition can result from various causes, including trauma, pericarditis, malignancy, or as a complication of cardiac procedures, as outlined in the 2015 ESC guidelines for the diagnosis and management of pericardial diseases 1. The key diagnostic findings for cardiac tamponade include:
- Tachycardia
- Hypotension
- Pulsus paradoxus (a drop in systolic blood pressure >10 mmHg during inspiration)
- Muffled heart sounds
- Jugular venous distention
- Electrical alternans on ECG
- Enlarged cardiac silhouette on chest X-ray Echocardiography is the single most useful diagnostic tool to identify pericardial effusion and estimate its size, location, and degree of hemodynamic impact, and it should be used as the first imaging technique to evaluate the size, location, and degree of hemodynamic impact of the pericardial effusion, as recommended by the ESC guidelines 1. The treatment of cardiac tamponade involves urgent pericardiocentesis or cardiac surgery, and as a nurse, you should prepare for emergency pericardiocentesis by gathering equipment, including a pericardiocentesis kit, cardiac monitor, ultrasound if available, and emergency medications like atropine and epinephrine, and positioning the patient at 45 degrees, monitoring vital signs continuously, and assisting with the procedure by preparing the chest area with antiseptic solution 1. After the procedure, you should monitor for complications such as dysrhythmias, pneumothorax, or reaccumulation of fluid, and understanding the underlying cause of cardiac tamponade is important for ongoing management, as it can quickly progress to cardiogenic shock and death if not treated promptly.
From the Research
Cardiac Tamponade Overview
- Cardiac tamponade is a medical emergency caused by the accumulation of pericardial fluid, blood, pus, or air in the pericardium, leading to haemodynamic compromise, circulatory shock, cardiac arrest, and death 2.
- The condition can be precipitated by dehydration, certain medications, or complications of interventional and surgical procedures or chest trauma 2.
Clinical Findings
- Key clinical findings in patients with cardiac tamponade include hypotension, increased jugular venous pressure, and distant heart sounds (Beck triad) 2.
- Patients may also experience dyspnoea, orthopnoea, weakness, fatigue, tachycardia, and oliguria 2.
- In cases of tamponade caused by acute pericarditis, patients may exhibit fever and typical chest pain increasing on inspiration and radiating to the trapezius ridge 2.
Diagnosis and Treatment
- Cardiac tamponade is a clinical diagnosis that can be confirmed using various imaging modalities, principally echocardiography 2, 3.
- The preferred treatment for cardiac tamponade is echocardiography-guided pericardiocentesis 2.
- Surgical management may be indicated in patients with aortic dissection, chest trauma, bleeding, or purulent infection that cannot be controlled percutaneously 2.
Prognosis
- The prognosis of cardiac tamponade is essentially related to its aetiology 3.
- Patients with cardiac tamponade and cancer or metastatic involvement of the pericardium have a poor short-term prognosis, while those with idiopathic pericarditis generally have a good long-term prognosis 3.
Pulsus Paradoxus
- Pulsus paradoxus is a significant decrease in arterial systolic pressure during inspiration, which can be used to estimate the level of hemodynamic embarrassment resulting from pericardial effusion 4, 5.
- A percentage decrease in arterial systolic pressure greater than 9% or an inspiratory decrease in arterial systolic pressure greater than 12 mmHg can indicate cardiac tamponade 4.