CCRN Cardiac Tamponade

CCRN Cardiac Tamponade

Cardiac tamponade, also known as pericardial tamponade, is a type of pericardial effusion in which fluid, pus, blood, clots, or gas accumulates in the pericardium (the sac in which the heart is enclosed), resulting in slow or rapid compression of the heart.

Cardiac tamponade is pressure on the heart muscle which occurs when the pericardial space fills up with fluid faster than the pericardial sac can stretch. If the amount of fluid increases slowly (such as in hypothyroidism) the pericardial sac can expand to contain a liter or more of fluid prior to tamponade occurring. If the fluid effusion occurs rapidly (as may occur after trauma or myocardial rupture) as little as 100 mL can cause tamponade.

Myocardial rupture is a somewhat uncommon cause of pericardial tamponade. It typically happens in the subacute setting after a heart attack, in which the infarcted muscle of the heart thins out and tears. Myocardial rupture is more likely to happen in elderly individuals without any previous cardiac history who suffer from their first heart attack and are not revascularized either with thrombolytic therapy or with percutaneous coronary intervention or with coronary artery bypass graft surgery.

One of the most common settings for cardiac tamponade is in the first 24 to 48 hours after heart surgery. After heart surgery, chest tubes are placed to drain blood. These chest tubes, however, are prone to clot formation. When a chest tube becomes occluded or clogged, the blood that should be drained can accumulate around the heart, leading to tamponade. Nurses will frequently clear clots from the tubes, but even with these efforts chest tubes can become clogged.

Signs and Symptoms

• anxiety and restlessness
• low blood pressure
• weakness
• chest pain radiating to your neck, shoulders, or back
• trouble breathing or taking deep breaths
• rapid breathing
• discomfort that’s relieved by sitting or leaning forward
• fainting, dizziness, and loss of consciousness

Causes

• gunshot or stab wounds
• blunt trauma to the chest from a car or industrial accident
• accidental perforation after cardiac catheterization, angiography, or insertion of a pacemaker
• punctures made during placement of a central line, which is a type of catheter that administers fluids or medications
• cancer that has spread to the pericardial sac, such as breast or lung cancer
• a ruptured aortic aneurysm
• pericarditis, an inflammation of the pericardium
• lupus, an inflammatory disease in which the immune system mistakenly attacks healthy tissues
• high levels of radiation to the chest
• hypothyroidism, which increases the risk for heart disease
• a heart attack
• kidney failure
• infections that affect the heart

Complications

• Heart failure
• Pulmonary edema
• Shock
• Death

Treatment

• Pericardiocentesis
• Pericardial Window
• Oxygen
• Thoracotomy
• Chest tubes