CARDIAC TAMPONAD

EShannen Whiddon

INTRODUCTION Cardiac tamponade is a condition in

which cardiac filling is impeded by an external force.

PATHOPHYSIOLOGY Cardiac tamponade is pressure on the

heart that occurs when blood or fluid builds up in the space between the heart muscle (myocardium) and the outer covering sac of the heart (pericardium). This large collection of fluid raises the pressure in the pericardial sac, compresses the cardiac chambers, and prevents blood from entering the heart.

(Osborn, Watson, Wraa, 2010)

PATHOPHYSIOLOGY Phase 1

The accumulation of pericardial fluid causes increased stiffness of the ventricle.

Phase 2The pericardial pressure increases above

the ventricular filling pressure, resulting in reduced cardiac output

Phase 3A further decrease in cardiac output occurs

due to equilibration of pericardial and LV filling pressures

NCLEX QUESTION The client with congestive heart failure

develops cardiac tamponade. Which of the following signs and symptoms would the nurse assess?A. Distant or muffled heart soundsB. HypertensionC. BradycardiaD. Increased urine output

NCLEX QUESTION The client with congestive heart failure

develops cardiac tamponade. Which of the following signs and symptoms would the nurse assess?A. Distant or muffled heart soundsB. HypertensionC. BradycardiaD. Increased urine output

PATHOPHYSIOLOGY Signs and symptoms

Chest pain, difficulty breathing, weak or absent peripheral pulses

Pulsus paradoxus Abnormally large decrease in systolic blood

pressure during inspiration (>10mmHg)

Beck’s triad (3 D’s)Distended jugular veinsDistant/muffled heart soundsDecreased arterial pressure

PATHOPHYSIOLOGY Risk factors

Heart surgeryDissecting aortic aneurysmAcute MIHypothyroidismPericarditis Injury to the heartEnd-stage lung cancerRadiation therapy to the chest

PATHOPHYSIOLOGY Prevalence of disease

Incidence rate: 2 in 10,000 in the U.S. (National Institute of Health, 2011).

Approximately 2% of penetrating injuries are reported to result in tamponade

1 year mortality rate of 76.5% in patients whose tamponade was caused by malignant disease

13.3% mortality rate in patients without malignant disease

Male-to-female ratio of 7:3

CASE STUDY HPI

A 63 year old woman faints after experiencing the sudden onset of severe chest pain that radiates to her back.

PMHHypertension

AssessmentHR is 110 bpm and BP is 90/50 Jugular veins distendedPulsus paradoxus

NCLEX QUESTION Which diagnostic test is best at

detecting cardiac tamponade?A. Chest X-rayB. EchocardiographyC. Electrocardiogram (ECG)D. Pulmonary artery pressure monitoring

NCLEX QUESTION Which diagnostic test is best at

detecting cardiac tamponade?A. Chest X-rayB. EchocardiographyC. Electrocardiogram (ECG)D. Pulmonary artery pressure monitoring

DIAGNOSIS Echocardiogram

Best diagnostic tool Chest X-Ray

Only helpful if there is at least 200mL of fluid in the pericardial sac

Chest CT or MRI Coronary angiography ECG

ECHOCARDIOGRAM

CHEST X-RAY

CURRENT TREATMENT Pericardiocentesis

Needle aspiration of blood or other fluid from the pericardial sac

Surgical pericardiectomy or pericardial windowProcedure to cut and remove part of the

pericardium Fluids to maintain normal BP Oxygen to reduce the workload on the

heart MUST TREAT THE CAUSE TO PREVENT

RECURRENCE

PERICARDIOCENTESIS

MEDICATIONS The role of medication therapy in

cardiac tamponade is limited Occasionally dobutamine may be used

to increase cardiac output Only drugs that do not cause an

increase in systemic vascular resistance

PROGNOSIS Often good if the condition is treated

promptly Often comes back after treatment This is a medical emergency and if left

untreated, the condition is rapidly and universally fatal

NURSING DIAGNOSIS

Decreased cardiac output R/T decreased preload and afterload AEB weak or absent peripheral pulses

REFERENCES Osborn, K., Watson, A., & Wraa, C. (2010). Medical-

Surgical Nursing Preparation for Practice. Pearson Education.

National Institute of Health (2012. May 14). Cardiac Tamponade. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000194.htm

Ross, G. and De Jong, M. (Feb., 1999). Emergency!: Pericardial Tamponade. The American Journal of Nursing. Retrieved from JSTOR.

The British Medical Journal (1972. May 06). Tamponade After Acute Myocardial Infarction. Retrieved from JSTOR.

Mayo Clinic Staff. (2011, April 29). Pericarditis. Retrieved from http://www.mayoclinic.com/health/pericarditis/DS00505/DSECTION=complications

TAMPONADE VIDEO http://www.youtube.com/watch?v=GhbK

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