Cardiac TamponadeCardiac Tamponade

Prepared ByPrepared By

Dr. Hanan Said AliDr. Hanan Said Ali

Learning ObjectivesLearning Objectives

Define Define cardiac tamponadecardiac tamponade..

Identify causes of Identify causes of cardiac tamponadecardiac tamponade..

Enumerate signs and symptoms of Enumerate signs and symptoms of disease.disease.

Explain how to diagnose the case.Explain how to diagnose the case.

Discus the Discus the Principles of care.Principles of care.

Cardiac TamponadeCardiac TamponadeDefinitionDefinition

It is a result o accumulation of excess It is a result o accumulation of excess pericardial fluid that compress the pericardial fluid that compress the heart.heart.

It is causing decreased cardiac filling, It is causing decreased cardiac filling, which leads to reduced cardiac output which leads to reduced cardiac output and shock.and shock.

Cardiac TamponadeCardiac Tamponade

Bleeding into the pericardial sac or Bleeding into the pericardial sac or small pericardial rupture may or may small pericardial rupture may or may not cause cardiac tamponade, not cause cardiac tamponade, depending on the amount of pressure in depending on the amount of pressure in the pericardium. the pericardium.

Cardiac TamponadeCardiac TamponadeThe pericardial sac normally holds about The pericardial sac normally holds about 25 ml of fluid, which serves to cushion and 25 ml of fluid, which serves to cushion and protect the heart.protect the heart.

Only a small amount of pericardial blood Only a small amount of pericardial blood ( 50 to 100 ml is necessary to increase ( 50 to 100 ml is necessary to increase intrapericardial pressure.intrapericardial pressure.

Cardiac TamponadeCardiac Tamponade

Continued bleeding increases the Continued bleeding increases the pressure rapidly and the patient present pressure rapidly and the patient present with signs of cardiac tamponade.with signs of cardiac tamponade.

Cardiac TamponadeCardiac Tamponade

Signs and SymptomsSigns and Symptoms

Decreased blood pressure.Decreased blood pressure.

abnormal heart sounds.abnormal heart sounds.

Increased central venous pressure.Increased central venous pressure.

Distended neck veins during inspirationDistended neck veins during inspiration

pulsus paradoxus (inspiratory decrease in pulsus paradoxus (inspiratory decrease in arterial blood pressure of more than 10 arterial blood pressure of more than 10 mm Hg from baseline)mm Hg from baseline)

Cardiac TamponadeCardiac Tamponade

ankle or ankle or sacral edema; edema; ascites; sacral edema; edema; ascites; hepatosplenomegaly.hepatosplenomegaly.

The patient may complain of dyspnea, The patient may complain of dyspnea, cough, and retrosternal pain that is cough, and retrosternal pain that is relieved by leaning forwardrelieved by leaning forward

A patient with a large effusion A patient with a large effusion experiences epigastric pain, hiccups, experiences epigastric pain, hiccups, hoarseness, nausea, and vomiting.hoarseness, nausea, and vomiting.

Cardiac TamponadeCardiac TamponadeDiagnostic Studies.Diagnostic Studies.

A chest film is used to determine the presence of A chest film is used to determine the presence of cardiac enlargement, mediastinal widening.cardiac enlargement, mediastinal widening.

The electrocardiogram (ECG) may show nonspecific The electrocardiogram (ECG) may show nonspecific abnormalities, including ST segment elevations, and abnormalities, including ST segment elevations, and T-wave changes.T-wave changes.

Echocardiography.Echocardiography.

Catheterization of the right side of the heart reveals Catheterization of the right side of the heart reveals pericardial tamponade.pericardial tamponade.

Cardiac TamponadeCardiac TamponadeNursing careNursing care

Place the patient in Trendelenburg’ Place the patient in Trendelenburg’ position, notify the physician.position, notify the physician.

Administer oxygen as ordered.Administer oxygen as ordered.

Prepare the patient for Pericardiocentesis.Prepare the patient for Pericardiocentesis.

Emergency Pericardiocentesis is life saving. Emergency Pericardiocentesis is life saving. Removal of 50 to 100 ml of fluid can bring Removal of 50 to 100 ml of fluid can bring major hemodynamic improvement.major hemodynamic improvement.

Cardiac TamponadeCardiac TamponadeNursing careNursing care

If a pericardial catheter is present, If a pericardial catheter is present, aspirate pericardial fluid, per orders.aspirate pericardial fluid, per orders.

Give fluids to increase preload Give fluids to increase preload (( The The amount of cardiac muscle fibres tension amount of cardiac muscle fibres tension or stretch that existing at diastole, just or stretch that existing at diastole, just before ventricular contractionbefore ventricular contraction))..

Discontinue agents that decrease preloadDiscontinue agents that decrease preload

( diuretic, nitrates, morphine)( diuretic, nitrates, morphine)