CARDIAC TAMPONADE

CARDIAC TAMPONADE

The normal pericardium is a fibroelastic sac containing a thin layer of fluid that surrounds the heart. When larger amounts of fluid accumulate (pericardial effusion) or when the pericardium becomes scarred and inelastic, one of three pericardial compressive syndromes may occur:

1.Cardiac tamponade –

2.Constrictive pericarditis –

3.Effusive-constrictive pericarditis –

The Beck triad of acute cardiac tamponade includes jugular venous distention (JVD) from an elevated central venous pressure(CVP), hypotension, and muffled heart sounds. In trauma,only one-third of patients with cardiac tamponade demonstrate this classic triad, although 90% have at least one of the signs.

The simultaneous appearance of all three physical signs is a late manifestation of tamponade and usually seen just prior to cardiac arrest. Other symptoms include shortness of breath, orthopnea, dyspnea on exertion, syncope, and symptoms of inadequate perfusion.

The clinical diagnosis of tamponade requires suspicion and a careful evaluation of the signs and, when available, imaging techniques. Bedside ultrasonography provides rapid diagnosis and facilitates pericardiocentesis. Emergency department pericardiocentesis is a diagnostic and resuscitative procedure in

patients with suspected cardiac tamponade.

Goals of emergency department pericardiocentesis include identification of pericardial effusion and removal of blood from the pericardial space to relieve the tamponade.

Pearls

1. Electrical alternans seen on a 12-lead ECG suggests pericardial effusion.

2. The Beck triad for acute cardiac tamponade is a late manifestation and is seen in only 30% of trauma patients.

3. Ultrasonographic identification of pericardial fluid in patients with penetration chest trauma may lead to life saving pericardiocentesis.

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