CARDIAC TAMPONADE

BY : AYOLEYI MERIT OMOJOYE

 DEFINITION
Cardiac tamponade is a life- threatening, slow or rapid compression of
the heart due to the pericaldial accumulation of fluid, pus, blood, clot
or gas as a result of effusion, truama.
which also results to restriction of blood flow in and out of the
ventricles therefore causing them not to expand fully.
 NORMAL PERICALDIAL ANATOMY
AND PHYSIOLOGY
 Pericardium is the membranous sac surrounding the heart.
 The pricadium consists of two layers : visclera and parietal layers.
 There is about 50ml pericardial fluid in the pericardial cavity.
 FUNCTIONS OF THE PERICARDIUM
 Maintaining an optimal cardiac shape.
 Reducing friction betwen heart and adjacent structures.
 Protecting the heart from other diseases which are caused by the
neighboring organs : inflammation, TB, cancer, etc.
 Preventing the overfilling of the heart.
 CAUSES
 Dissecting aortic aneurysm ( thorasic ).
 End-stage lung cancer.
 Acute myocardial infarction.
 Heart surgery.
 Percarditis caused by bacterial or viral infection.
 Wounds to the heart.
Others:
Kidney failure.
Hypothyroidism.
Heart tumors.
Leukemia.
Recent invasive heart procedures.
 PATHOPHYSIOLOGY
Acute pericardial effusion
↓
The pressure of the pericadial cavity↑
↓
FV ( filling volume) of the ventricular diastole↓
↓
SV ( stroke volume ) ↓
↓
Blood pressure↓
 SYMPTOMS
Elevated venous pressure.
Distended JVP ( kussmaul's sign).
Hypotension.
Tachycardia.
Narrow pulse pressure.
Dyspnoea.
Cyanosis of lips and nails.
Anxiety.
Decreased QRS voltage.
Pulsus paradoxus.
Muffled heart sound.
 BECK'S TRIAD
This is a collection of three medical sign associated with acute cardiac
tamponade, an emergency condition wherein fluid accumulates around
the heart and impairs its ability to pump blood.
The signs are low arterial blood pressure, distended JVP, and distant
muffled heart sound.
 PHYSIOLOGY
 The fall in arterial blood pressure results from pericardial fluid accumulation
to a degree that it impairs ventricular stretch, thus reducing stroke volume, a
major determinant of systolic blood pressure.
 The rising central venous pressure is evindenced by distended jugular veins
while in a non-supine position. It is caused by reduced diastolic filing of the
right ventricle, due to pressure from the adjacent expanding pericardial sac.
This results in a backup of fluid into the heart, most notably, the jugular veins.
 The suppressed heart sounds occur due to the muffling effects of the fluid
surrounding the heart.
 INVESTIGATIONS
 The pivotal investigation is ECHOCARDIOGRAPHY, which can confirm
the diagnosis and also helps to identify the optimum site for
aspiration of the fluid.
 A chest x-ray shows an enlarged globular heart.
 ECG.
 Cardiac catheterization.
 Coronary angiography.
 MRI scan.
 MANAGEMENT
• When the diagnosis is comfirmed, percutaneous pericardiocentesis
should be performed as soon as possible (it is a procedure to drain
the fluid around the heart).
• Medications to maintain normal blood pressure should be given.
• Antibiotics.
• Oxygen to reduce workload on the heart.