Cardiac Tamponade (Deep Dive R26)

Cardiac Tamponade

Cardiac Tamponade – A physiological state caused by a pericardial effusion in which the pressure in the pericardial sac is higher than the pressure inside the right sided chambers of the heart, leading to impaired filling, decreased cardiac output, and hemodynamic collapse.

Pericardial Effusions – Can be caused by infections, rheumatologic diseases, malignancy, uremia, hypothyroidism, trauma, aortic dissections, etc

Diagnosis on Exams:

* Becks Triad – Hypotension, JVD, Muffled Heart Sounds* Pulsus Paradoxus – SBP drops >10mmhg during inspiration* Electrical Alternans on ECG

Diagnosis in Real Life:

* Mix of clinical and cardiac ultrasound* Clinically patients usually complain of dyspnea, sometimes chest pain. They can have ALL, SOME, or NONE of the features of Beck’s Triad!* On ultrasound, RIGHT VENTRICULAR COLLAPSE DURING DIASTOLE is most specific for tamponade.* On ultrasound, a PLETHORIC IVC is most sensitive for tamponade (but is totally non-specific as we see this with many other conditions including CHF, PE, PNTX, etc)

Treatment:

* Initial fluid bolus (stop if they worsen clinically)* Vasopressors if needed to bridge unstable patient to definitive treatment* Definitive treatment is pericardiocentesis.

Further Reading:

NEJM – Diagnosis of Cardiac Tamponade and how to perform pericardiocentesis