Cardiac Tamponade

Accumulation of fluid within the pericardium leading to compression of cardiac chambers and a fall in cardiac output.

Epidemiology and Risk Factors

Pathophysiology

Aetiology

Clinical Manifestations

  • Mainly due to low CO or systemic venous congestion

Acute signs:

  • Pulsus paradoxus
  • Obstructive shock
    • Tachycardia
    • Hypotension
    • High CVP
    • Low UO
    • Metabolic acidosis

Chronic signs:

  • Right heart failure
    • Ascites
    • Exertional dyspnoea
    • Reduced exercise tolerance
    • Peripheral oedema

Diagnostic Approach and DDx

Investigations

Echocardiography:

  • Effusion
  • Diastolic collapse of RV
  • Systolic collapse of RA for >1/3rd of cardiac cycle
  • IVC dilatation ⩾20%
  • ⩽15% IVC respiratory variation
  • Swinging heart

ECG:

  • Low voltage
  • Electrical alternans

Management

Medical

Surgical

Needle pericardiocentesis:

  • For transudates or unclotted blood

Pericardial window:

  • For ongoing drainage

Resternotomy:

  • Tamponade occurring post cardiac surgery

Anaesthetic Considerations

  • A
  • C
    • Haemodynamic management is difficult
      • Often precarious anaesthetic induction
    • Inotropes
      Prepare for rapid reduction in requirement on relief of tamponade.
  • D
    • Processed EEG
      Low perfusion to high perfusion state.
    • Induction
      Surgeons scrubbed and ready prior.
      • Spontaneously ventilating gas induction
      • IV induction
        Benzodiazepines, opioids.
  • H
    • Coagulation status
    • Cell salvage

Marginal and Ineffective Therapies

Complications

Prognosis

Key Studies

References