Cardiac Tamponade

Definition/Etiology:

• Cardiac Tamponade– Pericarditis with a distinct clinical presentation when fluids fills pericardium too quickly.
• Pericardium Analogy: Even though the Pericardium is like the shell covering of the heart it has a space of two layers of material.
• Fist (representing the heart) pushed into the side of a deflated balloon (representing the serous pericardium), therefore enveloped by two individual layers of material.
• Etiology- 
  • Acute (Fast- ICU)
    • Trauma
      • Cath Lab procedures, CABG or CPR
    • Aortic Dissection
  • Chronic (Slower – PCU)
    • Infection/Inflammation

Pathophysiology:

• Tamponade Pathophysiology
  • Fluid RAPIDLY fills up pericardial space
  • 50cc → 150cc
    • Analog:The pericardium only holds 50cc of fluid, about the amount of a shot glass – at 150cc (3 shot glasses) Pericarditis can turn into Cardiac Tamponade.
  • ↑ Pericardium pressure
  • ↓ Ventricles filling = ↓ Output
  • Fluid backs up = ↑ CVP & ↑ JVD

Noticing: Assessment & Recognizing Cues:

• Subjective Cues: (Just like Pericarditis at first)
  • Orthopnea
  • Chest pain
    • Relieved by leaning forward
• Objective Cues:
  • Friction Rub -rubbing fingers next ears
    • 85% of patients
    • Bell of stethoscope
  • Beck’s Triad
    • Hypotension
    • Distended Neck Veins (↑ CVP)
    • Muffled Heart Sounds
  • Pulsus Paradoxus
    • Manual BP
      • Breath in = Korotkoff sounds
    • Arterial line
      • (dampened waves)

Interpreting: Analyzing & Planning:

• Labs
  • Troponin
    • Myocardial damage
  • CBC (WBC with diff)
    • Bacterial vs Viral
  • ERD/CRP
    • Inflammation
  • Blood Cultures
  • Pericardiocentesis Culture
• Diagnostics
  • Echocardiogram
    • How BIG is Effusion (Tamponade)
    • Heart swings
  • ECG
    • ST Elevations in most leads “Diffuse”
    • Tachyarrhythmias
    • ALTERNANS

Responding: Patient Interventions & Taking Action:

• Prepare for Procedure
  • Pericardiocentesis
  • Partial Pericardiectomy “window”
• Pharmacological Interventions
  • IV antibiotics
  • NSAIDS
  • Steroids
  • Colchicine
• Non-Pharmacological
  • 02
  • Positioning
• Adjunct Medical Therapy
  • Infectious Disease
  • Cardiac Surgeon

Reflecting: Evaluating Patient Outcomes:

• Treatment is directed toward the underlying disease.
• Hemodynamics, vital signs, and ECG are within normal limits.
• Patient is comfortable, pain free, and without symptoms.
• Patient is free from complications (HF, tamponade).
• Laboratory values and clinical findings return to normal, and blood culture results are negative.

Linchpins (Key Points):

• Notice
  • Pericarditis → Cardiac Tamponade
    • Becks Triad
    • Pulsus Paradoxus
• Interpret
  • ECHO/ECG/LABS
• Respond
  • MUST have surgical intervention for life
• Reflect
  • Patient’s trends improving