THE FORUM

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Cardiac tamponade

Cardiac tamponade is a clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise. The condition is a medical emergency, the complications of which include pulmonary edema, shock, and death.


Diagnostic Considerations:

Early diagnosis with a high index of suspicion is necessary to minimize morbidity and mortality from tamponade.

• Large pleural effusion

• Cases of cardiac tamponade have been reported with large pleural effusions. The increased intrapleural pressure resulting from large pleural effusions can be transmitted to the pericardial space and impair ventricular filling, thus producing the hemodynamic equivalent of cardiac tamponade.

• Tension pneumopericardium

• The hemodynamic changes in tension pneumopericardium simulate acute cardiac tamponade. Clinically, distant heart sounds, bradycardia, and shifting tympany occur over the precordium, and a characteristic murmur, termed bruit de la roue de moulin, is heard. Rapid and labored breathing

• Large decreases in intrathoracic pressure with deep inspirations, often observed during respiratory failure, can accentuate pulsus paradoxus, simulating pericardial tamponade.


Differential Diagnoses

Cardiogenic Shock

• Constrictive Pericarditis

• Effusive-Constrictive Pericarditis

• Pneumothorax

• Pulmonary Embolism


Nursing Actions:


1. Assess for and immediately report:

A. a sudden decrease in chest tube drainage

B. chest x-ray reports showing widening of the mediastinum

C. Signs and symptoms of cardiac tamponade (e.g. significant decrease in B/P, narrowed pulse pressure, pulsus paradoxus and distant or muffled heart sounds [may be obscured by mechanical ventilation], jugular vein distention, increased CVP).

2. Implement measures to reduce the risk of cardiac tamponade:

A. perform actions to maintain patency and integrity of chest drainage system.

B. if chest tube becomes obstructed, assist with clearing of existing tube and/or insertion of a new tube

C. When removing the pacemaker catheter(s), do it carefully to avoid trauma to the surrounding vessels and subsequent bleeding.

3. If signs and symptoms of cardiac tamponade occur:

A. prepare client for echocardiography

B. administer intravenous fluids and/or vasopressors if ordered to maintain mean arterial pressure

C. prepare client for surgical drainage of pericardial fluid.