CARDIAC TAMPONADE
Common causes:
- Neoplastic
- Pericarditis (infective or non-infective)
- Uraemia
- Cardiac instrumentation / trauma
- Acute pericarditis treated with anticoagulants
Diagnosis: - High index of suspicion (in acute case as little as 200ml of effusion can result in tamponade)
Signs & symptoms:
- Tachypnoea, tachycardia, small pulse volume, pulsus paradoxus
- Raised JVP with prominent x descent, Kussmaul’s sign
- Absent apex impulse, faint heart sound, hypotension, clear chest
Investigation:
1. ECG: Low voltage, tachycardia, electrical alternans
2. CXR: enlarged heart silhouette (when >250ml), clear lung fields
3. Echo: RA, RV or LA collapse, distended IVC, tricuspid flow increases & mitral flow decreases during inspiration.
Management:
1. Expand intravascular volume - D5 or NS or plasma, full rate if in shock
2. Pericardiocentesis with echo guidance – apical or subcostal approach, risk of damaging epicardial coronary artery or cardiac perforation
3. Open drainage under LA/GA
- permit pericardial biopsy (Watch out for recurrent tamponade due to catheter blockage or reaccumulation)
Treating tamponade as heart failure with diuretics, ACEI and vasodilators can be lethal!
Additional notes from Clinical Oncology:
For patients with neoplastic pericardial effusion resulting in cardiac
tamponade stabilized by urgent pericardial drainage, please consult oncologist to determine whether patient would benefit from surgical pericardiotomy (pericardial window) or pericardiectomy and to plan the subsequent oncological intervention for underlying disease control.
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