Cardiac tamponade

Cardiac tamponade occurs when fluid accumulates in the pericardium and exerts a pressure that exceeds intracardiac pressures, leading to impaired cardiac output

Normally the pericardial space contains 15-50mls of fluid. If fluid accumulates slowly it can accommodate up to 2l without causing tamponade; however, if it accumulates rapidly 150-200mls can result in tamponade. 

Possible causes of tamponade are any cause of a pericardial effusion. 

The classic clinical triad is Becks (present in 10 to 40% of cases): 
  • falling BP 
  • rising JVP 
  • muffled heart sounds

Other clinical signs and symptoms include:
  • Shortness of breath 
  • Chest pain 
  • Palpitations
  • Tachycardia
  • Pulsus paradoxus = increased fall in BP during inspiration >10mmHg - present in 98%
  • Raised JVP with decreased y descent 
  • Kussmaul’s sign = rising JVP on inspiration (more common in constrictive pericarditis than tamponade) 
  • Ewart’s sign = area of dullness and bronchial breathing below left scapular due to pericardial collection

  • ECG 
    • Low voltages complexes 
    • Electrical alternans (present in 10 to 20%) 
  • CXR
    • 'flask-like’ cardiac shadow if slow accumulation\
    • may be normal if rapid 
  • Echo 
    • RA+/-RV collapse during diastole 

Pericardiocentesis or cardiothoracic surgery 


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