Cardiac tamponade

Cardiac tamponade

Essence:
Pericardial fluid collects
intra-pericardial pressure rises
heart cannot fill
pumping stops.

Causes:
Trauma, lung/breast cancer, pericarditis, myocardial infarct, bacteria, eg TB.
Rarely: Urea, radiation, myxoedema, dissecting aorta, SLE.

Signs:
Falling BP,
a rising JVP,
and muffled heart sounds (Beck's triad);
JVP increase on inspiration (Kussmaul's sign);
pulsus paradoxus (pulse fades on inspiration).
Echocardiography may be diagnostic.

CXR: globular heart; left heart border convex or straight; right cardiophrenic angle <90.

ECG: electrical alternans.

Management:

This can be very difficult.
Everything is against you: time, physiology, and your own confidence, as the patient may be too ill to give a history, and signs may be equivocal but bitter experience has taught us not to equivocate for long.

Request the presence of your senior at the bedside (do not make do with telephone advice).
With luck, prompt pericardiocentesis brings swift relief.
While awaiting this, give O2, monitor ECG, and set up IVI.
Take blood for group and save.