Cardiac tamponade
Cardiac tamponade is a condition where a pericardial effusion compresses the heart, leading to life-threatening acute heart failure. This occurs if the pericardial effusion develops rapidly or is large. It’s an emergency which should be treated empirically even before a proper diagnosis is made.
Etiology
- Acute pericarditis
- Cardiac wall rupture (trauma, MI)
- Cardiac surgery
Clinical features
Cardiac tamponade has a distinct clinical presentation:
- Hypotension
- Tachycardia
- Jugular venous congestion
- Pulsus paradoxus
Diagnosis and evaluation
- ECG – low voltage, electrical alternans
- X-ray – enlarged cardiac silhouette
- Echocardiography – large effusion, collapse of chambers, swinging of the heart
Treatment
Treatment should not be delayed due to diagnostic evaluations. Treatment is by pericardiocentesis, under ultrasound or fluoroscopic guidance. If unsuccessful, surgery may be necessary.