Cardiac Tamponade

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
to form.

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.

Cardiogenic shock.


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.