Cardiac tamponade is caused by collection or accumulation of fluid or blood between the two layers of the pericardium. It is the most serious complication of pericarditis.
What causes it :
Trauma to the chest --> Cardiac contusion may occur. (Bruising of the heart muscle.) Blood and fluid leak into the pericardial sac.
Myocardial infarction --> Inflammation at the site of the infarction leads to increased capillary permeability. Fluid can leak into the pericardial sac resulting in a tamponade.
Cardiac bypass surgery --> Normally blood and fluid accumulate around the heart after heart surgery. Sometimes, though, one of the sutures to a graft may burst. This may cause sudden accumulation of blood in the mediastinum, resulting in a cardiac tamponade
Signs and symptoms :
Jugular vein distension (JVD) --> Heart is “squeezed” so blood cannot fill heart. Instead blood backs up into venous system, causing distension of jugular vein.
Drop in blood pressure The heart squeezes -->CO drops --> decreased forward flow of volume. Remember: less volume, less pressure.
Muffled heart sounds --> Fluid accumulates around the heart muffling heart sounds.
Pulsus paradoxus --> Blood pressure drops more than 10 mm Hg with inspiration. This is because with inspiration there is even more pressure “squeezing” down on heart.
Change in level of consciousness --> Decreased head perfusion due to drop (LOC) in CO.
Increased HR --> Compensation for drop in CO
Edema --> Blood backing up into the venous system
Tests Diagnostic :
Chest x-ray: widened mediastinum due to blood accumulation.
Echocardiography: detects compression of the heart, variation in blood flow in heart that occurs with breathing; shows fluid accumulation.
Electrocardiography: fast, slow, or normal HR with no pulse.
Echocardiography: monitors fluid removal.
Pericardiocentesis: removes fluid from the pericardium.
Percutaneous balloon pericardiotomy: drains fluid using a balloon-tipped
catheter inserted through the skin.
Subxiphoid limited pericardiotomy: drains fluid using a balloon-tipped
catheter inserted through a small incision in the chest.
Pericardiectomy: removal of the pericardium.
Sclerotheraphy: obliterates the pericardium by causing scar tissue
Oxygen therapy: increases oxygenation and tissue perfusion.
Intravascular volume expansion: increases blood volume and
Inotropic agents: controls heart rate and decreases atrial fibrillation.
What can harm my client?
A sudden accumulation of fluid in the pericardial sac or mediastinum is a medical emergency.
What to do?
Assessment for cardiac output.
Clients at risk for cardiac tamponade.
Causes and why.
Signs and symptoms and why.
Pre- and postop care.
IV administration and complications.
Patient teaching regarding bed rest, when to notify the doctor, and
postop infection prevention.
Read More ..