Cardiac Tamponade

Stevie Newmark, PA-S

Immad Hussaini, PA-S
Description of condition
Cardiac tamponade is a medical emergency caused by a
buildup of fluid or air in the pericardium putting pressure
on the heart and preventing the heart from expanding
properly.

A pericardial effusion is a progressive accumulation of

fluid, pus, blood, or gas in the pericardial cavity. Pericardial
effusion happens slowly, allowing the heart to adapt to the
slow increase in pressure. When too much pressure
accumulates too quickly, a pericardial effusion can result
in cardiac tamponade.
Causes Cardiac tamponade can be caused by a rapid
accumulation of fluid in the pericardium. Pericardial
effusion can also lead to cardiac tamponade.

Causes of acute cardiac tamponade:

- Complication of cardiac surgery (eg aortic

dissection)
- Chest trauma (stab wound, blunt trauma, etc)
- Rupture of weakened ventricle after an MI
- Acute pericarditis
- Ruptured aorta

Causes of pericardial effusion:

- Long-term pericarditis
- Pericardial infection
- Cancer
Causes
Signs and Symptoms Possible findings on physical exam:

Beck’s Triad:
- Hypotension
- JVD
- Diminished heart sounds

Chest Pain
Dyspnea
Cough

Tachycardia
Pulsus paradoxus
How diagnosis is made
ECG - Low voltage ECG

CXR - Will see enlarged cardiac silhouette, fluid

in lungs

Echo - High intrapericardial pressure may

collapse RA and RV on imaging.

Cardiac CT - will demonstrate pericardial fluid

and pericardial thickening
Flow chart of diagnostic
test usage
CXR

Chest radiographs may not be useful early in the

course of the process, since at least 200 mL of
pericardial fluid must accumulate before visible
enlargement of the cardiac silhouette occurs
https://pubs.rsna.org/doi/10.1148/rg.276065002
CXR - Normal

https://radiopaedia.org/cases/normal-frontal-chest-x-ray?lang=us
CXR - Cardiac Tamponade

https://www.acc.org/latest-in-cardiology/articles/2019/09/09/10/46/chest-
radiograph-signs-suggestive-of-pericardial-disease
CXR - Cardiac Tamponade
“Water bottle” sign

https://radiopaedia.org/articles/cardiac-tamponade?lang=us
Echocardiogram
Diagnostic.

Will see signs related to problems with filling of

the heart

1. Pericardial effusion
2. Diastolic collapse of the right atrium
3. Diastolic collapse of the right ventricle
4. Swinging heart
5. Others
Echocardiogram- Normal

Ref: https://echobasics.de/tte-en.html
Echocardiogram-
Cardiac Tamponade
Right atrial collapse

Ref: Dr. Steve R Ommen

Echocardiogram- Normal

Ref: https://echobasics.de/tte-en.html
Echocardiogram- Cardiac
Tamponade

Ref: Ali Haider, M.D., Instagram.com/yourheartdoc

Echocardiogram- Cardiac
Tamponade

Ref: Sam Ghali, M.D., Twitter.com/EM_RESUS

Echocardiogram - Cardiac
Tamponade
Slowed down 70%

Ref: youtube.com/TATDUS, Ozgur Dikme, M.D.

 Echocardiography is first line imaging for tamponade
Role of Computed
CT does have some advantages:
Tomography -Larger field of view

-Less operator dependent

-Lower rate of false-positive findings

-Accurate identification of cause or other pathologic

conditions and exact location of fluid
 CT provides information about the possible nature of
CT pericardial effusions based on the measurements of
the collection.

Possible CT findings in tamponade:

- Superior vena cava enlargement: diameter

similar to or greater than that of the adjacent
thoracic aorta
- Inferior vena cava enlargement: diameter
greater than twice that of the adjacent
abdominal aorta
- Hepatic and renal vein enlargement
- Flattened heart sign
- Angulation of the interventricular septum

https://pubs.rsna.org/doi/10.1148/rg.276065002#F8
 CT provides information about the possible nature of
CT pericardial effusions based on the measurements of
the collection.

Causes of tamponade demonstrated on CT:

- Malignant pericardial disease

- Other cancers
- Penetrating trauma
- Aortic dissection and aneurysm rupture
- Mediastinal pathology
- Tuberculosis
CT - Normal

https://radiopaedia.org/cases/coronary-artery-ct-normal?lang=us Case courtesy of

Dr Sarah Kalus, Radiopaedia.org, rID: 46015
CT -
Cardiac
Tamponade

Restrepo CS. Published Online: November 01, 2007

https://doi.org/10.1148/rg.276065002
CT -
Cardiac
Tamponade

Restrepo CS. Published Online: November 01, 2007

https://doi.org/10.1148/rg.276065002
CT -
Cardiac
Tamponade

Restrepo CS. Published Online: November 01, 2007

https://doi.org/10.1148/rg.276065002
 Treatment for tamponade is to drain the pericardial
Conclusion fluid. This can be done under echocardiographic,
fluoroscopic, or CT guidance.

Echocardiography is the first line imaging in patients

with suspected tamponade

CT can be useful if echocardiographic findings are

inconclusive
References Hernández Castillo, A. Pericardial Tamponade. Osmosis.
https://www.osmosis.org/answers/pericardial-tamponade

Pérez-Casares, A., Cesar, S., Brunet-Garcia, L., &

Sanchez-de-Toledo, J. (2017). Echocardiographic
Evaluation of Pericardial Effusion and Cardiac
Tamponade. Frontiers in pediatrics, 5, 79.
https://doi.org/10.3389/fped.2017.00079

Pericarditis. (2019, May 3). Cleveland Clinic.

https://my.clevelandclinic.org/health/diseases/17353-peric
arditis

Restrepo, C. S., Author Affiliations1From the Department

of Radiology, Bogaert, J., Dreizin, D., Restrepo, C. S., &
Co, S. J. (2007, November 1). @RadioGraphics.
RadioGraphics. Retrieved October 17, 2021, from
https://pubs.rsna.org/doi/10.1148/rg.276065002.
Questions Thank you!