Cardiac Tamponade

Cardiology

Pericardial fluid accumulation impairs diastolic filling.

Causes

  • Malignancy, uraemia, TB
  • Post-MI (free wall rupture)
  • Trauma, aortic dissection
  • Post-cardiac surgery/procedure

Clinical features

  • Dyspnoea, hypotension
  • Beck's triad: hypotension, muffled sounds, raised JVP
  • Pulsus paradoxus >10 mmHg

Investigations

  • Bedside echo (RV diastolic collapse)
  • ECG (low voltage, electrical alternans)
  • CXR (globular heart)

Management

  • IV fluid 500 mL bridge
  • Urgent pericardiocentesis (echo-guided subxiphoid)
  • Avoid PEEP, vasodilators, diuretics
  • Treat cause

Related in WardRound

Educational — verify locally.

WardRound

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Clinical Decisions in Seconds