The presentation of patients with cardiac tamponade largely depends upon the length of time over which pericardial fluid accumulates and the clinical situation. Aetiology and management of acute cardiac tamponade. The fluid may be blood, pus, effusion transudate or exudate or air and treatment involves correction of the cardiac diastolic restriction by removing pericardial fluid. Objectives this was a retrospective analysis of a registry of patients who underwent catheter ablation for atrial fibrillation af under uninterrupted direct oral anticoagulant doac and warfarin administration. Supportive findings include equalization of diastolic pressures between cardiac chambers, which produces a characteristic blunted ydescent in the right atrial tracing fig. Satoshi yanagisawa, yasuya inden, shiou ohguchi, tomoyuki nagao, aya fujii, toshiro tomomatsu, keita mamiya, hiroya okamoto, yusuke sakamoto, rei shibata and toyoaki murohara. Pericardiocentesis is life saving in cardiac tamponade level of evidence b, class i indication and indicated in ef fusions 20 mm in echocardiography. Scribd is the worlds largest social reading and publishing site. Many cardiac tamponade patients exhibit the classic beck triad.
Tamponade is a continuum from mild impairment in cardiac filling to complete circulatory collapse. Acute cardiac tamponade is life threatening and requires prompt pericardial drainage. Cardiac tamponade is a clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise. Fig 2 the cals algorithm for the management of postoperative cardiac arrest following cardiac surgery. Cardiac tamponade is a hemodynamic condition characterized by equal elevation of atrial and pericardial pressures, an exaggerated inspiratory decrease in arterial systolic pressure pulsus paradoxus, and arterial hypotension.
Periprocedural management of cardiac tamponade during catheter ablation for af under uninterrupted doac and warfarin. May 31, 2017 invasive hemodynamic monitoring with a pulmonary arterial catheter can provide additional evidence for the diagnosis of cardiac tamponade. Cardiac tamponade is a condition caused by the compression of the heart due to slow or rapid accumulation of fluid exudate, pus, blood, clots. Cardiac tamponade is always life threatening and nearly always requires urgent and precise therapeutic intervention.
The goals of the treatment are relief of tamponade and prevention of reaccumulation of fluid, which is frequent in these patients. The management of cardiac arrest 49 asystole this is the most common arrest rhythm in children, because the response of the young heart to prolonged severe hypoxia and acidosis is progressive bradycardia leading to asystole. Cardiac tamponade is caused by a large or uncontrolled pericardial effusion, i. It is perhaps unique in that appreciation of its pathophysiologic state is essential to precise diagnosis and rational treatment. The normal pericardium can stretch to accommodate physiologic changes in cardiac volume.
Acute postoperative cardiac tamponade defined as up to 7 days postsurgery1 is an uncommon entity that requires prompt diagnosis and diligent management to avoid circulatory collapse and. Although the incidence of ct is not higher when rfca is performed with a therapeutic international normalized ratio inr, outcomes of ct are unclear. Diagnosis, management, and clinical outcome of cardiac. Cardiac tamponade an overview sciencedirect topics. Presentation, diagnosis and differential pericardial anatomy and physiology pericardial pathology tamponade. Triage strategy for urgent management of cardiac tamponade. Traumatic pericardial tamponade emergency management. The fluid around the heart must be drained as quickly as possible. Acute postoperative cardiac tamponade defined as up to 7 days postsurgery1 is an uncommon entity that requires prompt diagnosis and diligent management to. Cardiac tamponade symptoms, diagnosis and treatment.
Arising secondary to conditions causing acute or chronic pericardial inflammation and subsequent pericardial effusion hiv, sle, tb, malignancy, severe hypothyroidism, uremia, etc. As cardiac tamponade is a clinical syndrome it needs a medical emergency that focuses mainly on the stability of patients and drainage of the precordial fluid around the pericardium of the heart. This commonly occurs as a result of chest trauma both blunt and penetrating, but can also be caused by myocardial infarction, myocardial rupture, cancer, uremia, pericarditis, or cardiac surgery, and rarely occurs during retrograde aortic dissection, or while. Pdf management of cardiac tamponade after cardiac surgery. Cardiac tamponade is the accumulation of excess fluid within the pericardial space, resulting in impaired cardiac filling, reduction in stroke volume, and epicardial coronary artery compression with resultant myocardial ischemia. Guidelines on the diagnosis and management of pericardial diseases full text the task force on the diagnosis and management of pericardial diseases of the european society of cardiology task force members, bernhard maisch, chairperson germany, petar m. Right atrial collapse may be seen in patients with hypovolemia who do not have tamponade. The visceral pericardium is a serosal monolayer that adheres firmly to the epicardium, reflects over the origin of the great vessels, and together with a tough, fibrous parietal layer, envelops the heart. B, a parasternal longaxis tte image demonstrating a cardiac tamponade. Cardiac tamponade is defined as a haemodynamically significant cardiac compression caused by pericardial fluid. We discuss the causes, symptoms, and treatment of cardiac tamponade here. Management of cardiac tamponade in catheter ablation of atrial fibrillation. Diagnosis, management, and clinical outcome of cardiac tamponade.
An update on the deadly condition of cardiac tamponade, with pearls in management and the necessary procedures to save a patients life. The incidence is 2 cases per 10,000 population in the united states of america. The following are true regarding the management of cardiac tamponade. It is a safe, simple, and widely available procedure with few complications if it is done under echocardiographic guidance. Cardiac tamponade associated with hypothyroidism has been reported, but few studies address the clinical features. Cardiac tamponade ct is a possible complication of radiofrequency catheter ablation rfca of atrial fibrillation af. A main strategy for the management of cardiac tamponade, pericardiocentesis must be performed quickly, often under technically challenging conditions in hemodynamically unstable patients with. Cardiac tamponade causes, signs, symptoms, diagnosis and. Management of cardiac arrest following cardiac surgery. The author has disclosed no potential conflicts of interest, financial or otherwise.
Cardiac tamponade is a fluid buildup around the heart that constitutes a medical emergency. Periprocedural management of cardiac tamponade during. The accumulation of pericardial fluid or pericardial. Spectrum of hemodynamic changes in cardiac tamponade. In both cardiac tamponade and constrictive pericarditis, cardiac filling is impeded by an external force. Anesthestic management for suspected cardiac tamponade could include arterial monitoring and cvp. If reading the pdf online, click on the image to view the video. Defination cardiac tamponade is a life threatening complication caused by accumulation of fluid in the pericardium this fluid,which can be blood,pus,or air in the pericardial sac, accumulates fast enough and in sufficient quantity to compress the heart and restrict blood flow in and out of the ventricles. Since the 19th century, investigations in experimental animals provided a basic understanding that has been continually refined by.
Pdf acute postoperative cardiac tamponade defined as up to 7 days postsurgery1 is an uncommon entity that requires prompt. Cardiac tamponade remains an uncommon complication observed in 0. Cardiac tamponade is a cardiac emergency and can be fatal if it is not quickly diagnosed and treated promptly. Scoring system, triage, and management of cardiac tamponade immediate drainage of pericardial effusion in cardiac tamponade. The task force for the diagnosis and management of pericardial. Cardiac tamponade, also known as pericardial tamponade, is when fluid in the pericardium the sac around the heart builds up, resulting in compression of the heart. Data on medical history, characteristics of the pericardial fluid, treatment strategy, and followup data were collected. Pericardiocentesis is indicated in all forms of cardiac tamponade b. The condition is a medical emergency, the complications of which include pulmonary edema, shock, and death. Guidelines on the diagnosis and management of pericardial. Apr 01, 2020 cardiac tamponade remains an uncommon complication observed in 0. Lendell richardson is medical director and an associate professor in the pa program at midwestern university in downers grove, ill. Methods of 3,149 catheter ablation procedures for af.
Web figure 4 triage cardiac tamponade proposed by the european society of cardiology. Pericardiocentesis is only diagnostic in the management of cardiac tamponade 3. Oct 23, 2018 cardiac tamponade is a fluid buildup around the heart that constitutes a medical emergency. Background uninterrupted doac used during catheter ablation for af causes a lifethreatening bleeding risk of cardiac tamponade. Cardiac tamponade related to trauma or hiv is more common in young adults. Guidelines on the diagnosis and management of pericardial diseases. Varies according to the sizerate of accumulation of the pericardial effusion. Cardiac tamponade and management free download as powerpoint presentation. Treatment involves careful fluid resuscitation and inotropes. It can complicate a number of medical conditions and it is important, therefore, that all practitioners are aware of its presentation, diagnosis and management.
Pericardiocentesis alleviates symptoms in most cases. Cardiac tamponade is a sudden life threatening condition characterized by the accumulation of pericardial fluid under pressure which decreases the movement of parietal pericardium and compresses all the chambers such that systemic venous return to the ra is compromised 35. Olenchock case presentation a 64yearold man with a remote history of stage iiia adenocarcinoma of the lung treated with chemotherapy and radiation presented to the emergency department complaining of leftsided chest pain and dyspnea. Cardiac tamponade is the accumulation of pericardial fluid, blood, pus, or air within the pericardial space that creates an increase in intrapericardial pressure, restricting cardiac filling and decreasing cardiac output. Dec 20, 20 defination cardiac tamponade is a life threatening complication caused by accumulation of fluid in the pericardium this fluid,which can be blood,pus,or air in the pericardial sac, accumulates fast enough and in sufficient quantity to compress the heart and restrict blood flow in and out of the ventricles. The pericardium is composed of visceral and parietal components. In about 25 percent of patients, the left atrium also collapses, and this finding is highly specific for tamponade. With the growth of acute bedside echocardiography tamponade diagnosis is likely to increase and thus knowledge of its management is a. We suggest that, with certain specific and important exceptions, percutaneous. This study aims to identify the patient characteristics and to propose a reasonable clinical approach for hypothyroid cardiac tamponade. Clinical sings of cardiac tamponade depends on the rapidity of the fluid accumulation and on the fluid volume. The diagnosis of cardiac tamponade is essentially a clinical diagnosis requiring echocardiographic confirmation of the initial diagnostic suspicion.
Management of cardiac tamponade in catheter ablation of atrial. The management of cardiac tamponade in patients with secondary neoplastic pericardial involvement has two targetsrelief of symptoms, and prevention of recurrences. However, after its reserve volume is exceeded, the pericardium markedly stiffens. In both cardiac tamponade and constrictive pericarditis, cardiac filling is. Cardiac tamponade is the classic cause of pulsus paradoxus, but it can also be seen from a pe or hypovolemic shock. The primary determinant of the hemodynamic significance of a pericardial effusion. Cardiac tamponade is an emergency condition that needs to be treated in the hospital. In most patients, cardiac tamponade should be diagnosed by a clinical examination that shows elevated systemic venous pressure, tachycardia, dyspnoea, and paradoxical arterial pulse. The role of ultrasound in patients with possible penetrating cardiac wounds. The physical findings are dictated by both the severity of cardiac tamponade and the time course of its development. At first, a patient needs prehospital care so firstly, prehospital care. May 09, 2020 a main strategy for the management of cardiac tamponade, pericardiocentesis must be performed quickly, often under technically challenging conditions in hemodynamically unstable patients with. Nov 28, 2018 cardiac tamponade is a clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise.
Cardiac tamponade occurs when fluid accumulates in the intrapericardial space, increasing intrapericardial pressure and impairing cardiac filling. Cardiac tamponade is a emergency condition that needs to be treated in the hospital due to compression of the heart caused by the accumulation of pericardial fluid or pericardial effusion transudate, exudate, or blood in the space between the heart muscle and the outer covering sac of the heart 1. May 26, 2011 the management of cardiac tamponade in patients with neoplastic pericardial involvement merits a special comment. The management of cardiac tamponade in patients with neoplastic pericardial involvement merits a special comment. Management of pericardial effusion european heart journal. Management and outcomes of cardiac tamponade during atrial. Tamponade due to malignancy andor chronic kidney injury occurs more frequently in elderly individuals. Urgent pericardiocentesis or drainage of pericardial effusion is indicated for each patient with established diagnosis of cardiac tamponade and haemodynamic shock. Lendell richardson is medical director and an associate professor in the pa program at midwestern. Cardiac tamponade ct represents a lifethreatening condition, and the optimal method of draining accumulated pericardial fluid remains controversial. A procedure that uses a needle to remove fluid from the tissue that surrounds the heart will be done. Now, the cardiac tamponade treatment is described in detail way. A comperative study between echoguided pericardiocentesis and surgerya report of 100 patients. Symptoms typically include those of cardiogenic shock including shortness of breath, weakness, lightheadedness, and cough.
1480 430 596 237 982 1588 103 704 301 628 690 462 268 863 50 225 1466 286 964 912 179 1592 1134 1129 705 286 1378 1350 924 1484 438 1217 970