Cardiac tamponade

Introduction

Cardiac tamponade is defined as the accumulation of fluid in the pericardial space that surrounds the heart, between the parietal and visceral membranes of the pericardium.

Tamponade results in reduced ventricular filling and subsequent hemodynamic compromise.

The condition is a medical emergency, which may lead to cardiogenic shock and death.

Etiology 

  • malignant diseases
  • uremia
  • idiopathic pericarditis
  • infections 
  • iatrogenic
  • Dressler’s syndrome 
  • connective tissue diseases
  • pericarditis

Clinical presentation

  • tachycardia
  • tachypnea
  • dyspnea
  • cold extremities
  • distended jugular veins 
  • chest pain or pressure
  • pulsus paradoxus (fall in systolic blood pressure of 10 mmHg or more during inspiration)

Echocardiography signs of tamponade

  • right atrial systolic collapse
  • right ventricular diastolic collapse
  • abnormal respiratory variation of transvalvular flow
  • distended inferior vena cava without respiratory variation
  • swinging heart

ECG manifestation 

  • sinus tachycardia
  • low QRS voltage
  • electrical alternans (alternation of QRS complex amplitude or axis between beats)
  • PR segment depression 


Picture 1 Electrical alternans (alternation of QRS complex amplitude or axis between beats)

ECG 1 Cardiac tamponade (low QRS voltage)

ECG 2 Cardiac tamponade (low QRS voltage, borderline sinus tachycardia)

Management

  • pericardiocentesis

References

  1. Ang KP, Nordin RB, Lee SCY, Lee CY, Lu HT. Diagnostic value of electrocardiogram in cardiac tamponade. Med J Malaysia. 2019 Feb;74(1):51-56. PMID: 30846663.
  2. https://emedicine.medscape.com/article/152083-overview
  3. Mark J. Eisenberg,Luisa Munoz De Romeral,Paul A. Heidenreich,Nelson B. Schiller,G. Thomas Evans. The Diagnosis of Pericardial Effusion and Cardiac Tamponade by 12-Lead ECG A Technology Assessment. https://doi.org/10.1378/chest.110.2.318. Copyright © 1996 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.