James Peerless September 2015 Cardiac Tamponade James Peerless September 2015

Cardiac Tamponade First described by Galen ~200AD gladiator chest wounds Important excluder in ALS Incidence of 0.1 – 6% after cardiac surgery Highest incidence: Valvular surgery Anticoagulation therapy

Tamponade Accumulation of fluid in pericardial sac creating an increased pressure Physiological diagnosis cf. p. effusion, which is anatomical.

Stages Early Late

Symptoms vary largely due to rate of accumulation of fluid

Physiological Compensation Increase in sympathetic tone to maintain MAP Increased HR Increased SVR Activation of RAA Fluid retention Elevated CVPs improves diastolic filling

Signs Beck’s Triad Pulsus paradoxus Hypotension Elevated JVP Muffled HS Pulsus paradoxus Fall in MAP with inspiration Rise in RV pressures

Management Diagnosis Resus Treatment High suspicion / Echo / [CXR, ECG] Resus A, B, C Fluids and inotropes, SV Treatment Pericardiocentesis / Surgical drainage

Summary Life-threatening Symptoms dependent of rate of formation Prompt echo as mainstay of diagnosis Careful fluid resus and inotropes Definitive treatment - drainage