Pericardial Tamponade: Recognitions and Management
Department of Pediatric, Faculty of Medicine, Universitas Gadjah Mada Sardjito Hospital
Cardiac tamponade is a sudden life threatening condition that occurs when pericardial fluid accumulates under high pressure. As fluid accumulates, the pressure generated compresses the cardiac chambers, resulting in decreased preload, decreased ventricular filling, decreased myocardial compliance, and ultimately reduced cardiac output.
These clinical feature correlated with the hemodynamic changes. Most commonly a patients with pericardial tamponade develops sinus tachycardia to compensate for decreased stroke volume. Jugular venous pressure usually elevated. Pulsus paradoxus is a key finding in patients with pericardial tamponade.
Echocardiography is the main diagnostic tool for cardiac tamponade. LA collapse is very specific for cardiac tamponade, while persistent RA collapse for more than one-third of the cardiac cycle and RV diastolic collapse are highly sensitive and specific for cardiac tamponade.
The treatment of choice in hemodynamically unstable patients with acute cardiac tamponade is percutaneous catheter pericardiocentesis or surgical pericardiectomy. However in stable patients, hemodynamic monitoring with serial echocardiography and treatment of the underlying cause is recommended.