1. James Peerless September 2015
Cardiac Tamponade
James Peerless
September 2015

2. 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

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

4. Stages
Early
Late

5. Symptoms vary largely due to rate of accumulation of fluid

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

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

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

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