Cardiac Tamponade
A rapid rise in intrapericardial pressure impairs diastolic filling of the heart in cardiac tamponade. The rise in pressure usually results from blood or fluid accumulation in the pericardial sac. If fluid accumulates rapidly, as little as 250 ml can create an emergency situation. Slow accumulation and rise in pressure, as in pericardial effusion associated with cancer, may not produce immediate signs and symptoms because the fibrous wall of the pericardial sac can gradually stretch to accommodate as much as 1 to 2 L of fluid.
Causes
Cardiac tamponade may be idiopathic (Dressler’s syndrome) or may result from:
effusion (in cancer, bacterial infections, tuberculosis and, rarely, acute rheumatic fever)
hemorrhage from trauma (such as gunshot or stab wounds of the chest, perforation by catheter during cardiac or central venous catheterization, or after cardiac surgery)
hemorrhage from nontraumatic causes (such as rupture of the heart or great vessels or anticoagulant therapy in a patient with pericarditis)
viral, postirradiation, or idiopathic pericarditis
acute myocardial infarction
chronic renal failure during dialysis
drug reaction (procainamide, hydralazine, minoxidil, isoniazid, penicillin, methysergide, and daunorubicin)
connective tissue disorders (such as rheumatoid arthritis, systemic lupus erythematosus, rheumatic fever, vasculitis, and scleroderma).
Complications
Pressure resulting from fluid accumulation in the pericardium decreases ventricular filling and cardiac output, resulting in cardiogenic shock and death if untreated.
Assessment
The patient’s history may show a disorder that can cause cardiac tamponade. He may report acute pain and dyspnea, which forces him to sit upright and lean forward to ease breathing and lessen the pain. He may be orthopneic, diaphoretic, anxious, restless, and pale or cyanotic. You may note neck vein distention produced by increased venous pressure, although this may not be present if the patient is hypovolemic.
Palpation of the peripheral pulses may disclose rapid, weak pulses. Palpation of
the upper quadrant may reveal hepatomegaly.
the upper quadrant may reveal hepatomegaly.
Percussion may detect a widening area of flatness across the anterior chest wall, indicating a large effusion. Hepatomegaly may also be noted.
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