CARDIAC TAMPONADE ( Cardiac emergency) • Cardiac Tamponade is a life threatening complication caused by excessive accumulation of fluid in the pericardium. Or • Compression of all cardiac chambers due to excessive accumulation of pericardial fluid leading to compromised cardiac out put.

1. CARDIAC TAMPONADE
MR. ANILKUMAR BR MS.C NURSING
LECTURER MEDICAL-SURGICAL NURSING

2. CARDIAC TAMPONADE

3. INTRODUCTON
• The heart is surrounded by a membrane covering
called the “ Pericardial sac”.
• The pericardial sac consists of mainly two layers
1. The Parietal layer ( outer layer) &
2. The visceral layer ( inner layer) and normally
contains a small amount of fluid to cushion &
lubricate the heart as it contracts & expands.

4. PERICARDIUM

5. PERICARDIUM
• Pericardium is the membranous sac surrounding the
human heart.
• There is about normally 20 to 50 ml pericardial fluid
in the pericardial cavity.

6. THE NORMAL FUNCTIONS OF PRICARDIUM
1) Maintaining an optimal cardiac shape
2) Reducing friction between the beating heart &
adjacent structures
3) Protecting the heart from other disease which are
caused by the neighboring organs ( inflammation, TB
etc)
4) Prevent overfilling of the heart.

7. CARDIAC TAMPONADE ( Cardiac emergency)
• Cardiac Tamponade is a life threatening complication caused
by excessive accumulation of fluid in the pericardium. Or
• Compression of all cardiac chambers due to excessive
accumulation of pericardial fluid leading to compromised
cardiac out put.

8. CARDIAC TAMPONADE ( Cardiac emergency)
• Cardiac tamponade is the accumulation of excess fluid within
the pericardial space, resulting in impaired cardiac filling,
reduction in stroke volume, and epicardial coronary artery
compression with resultant myocardial ischemia.

9. CARDIAC TAMPONADE ( Cardiac emergency)
• This fluid, which can be blood , pus, or air in the pericardial
sac. Accumulates fast enough and in sufficient quantity to
compress the heart and restrict blood flow in & out of the
ventricles.

10. ETIOLOGICAL RISKFACTORS OF PERICARDIAL
TAMPONADE
• Malignancy ( end stage of lung tumor)
• Infection ( viral, (HIV) bacterial , (TB) & fungal pericarditis)
• Cardiovascular surgery ( open heart surgery , CABG)
• Post coronary intervention ( coronary dissection , &
perforation)

11. ETIOLOGICAL RISKFACTORS OF
PERICARDIAL TAMPONADE
• Post myocardial infraction ( after MI or heart attack)
• Connective tissue disorders ( SLE, Rheumatoid arthritis)
• Iatrogenic (after sterna biopsy, pericardiocentasis, central IV
line insertion and transvenous pacemaker lead implantation &
radiation therapy to the chest)

12. ETIOLOGICAL RISKFACTORS OF
PERICARDIAL TAMPONADE
 Uremia
 Drugs and medications such as antiarrhythmic drugs
antihypertensive drugs ( e.g. MINOXIDIL, HYDRALAZINE ,
PROCAINAMIDE)

13. ETIOPATHOPHYSIOLGY
Abnormal amounts of fluid may result from :
1. Pericarditis ( infection viral, bacterial, fungal)
2. Trauma ( abnormal blood, pus, fluid due to an trauma)
3. Surgery & invasive cardiac diagnostic & therapeutic
procedures.
4. MI ( Post –MI)

14. ETIOPATHOPHYSIOLGY
• The rate of pericardial fluid accumulation is important
• If fluid accumulation develops slowly or gradually then
problems with blood flow will not affect . until excessive amount
or massive ( large) fluid collection.
• When there is a massive rapid excessive fluid build-up or
blood in the pericardial cavity, the resulting compression on the
heart and impairs the pumping action of the vascular system
and finally ultimately leading to decrease stroke volume ( SV)
& cardiac output (CO).

15. PATHOPHYSIOLGY

16. CLINICAL FEATURES

17. BECK’S TRAID IS ACOLLECTION OF THREE MEDICAL
SIGNS ASSOCIATED WITH ACUTE CARDIAC TAMPONADE

18. CLINICAL FEATURES
OTHER SYMPTOMS INCLUDE:
1. Tachycardia
2. Narrow pulse pressure
3. Dyspnoea
4. Cyanosis of lips and nails
5. Restlessness & anxiety
6 . Muffled heart sounds and decreased QRS voltage

19. MANAGEMENT
The main aim of client with cardiac Tamponade is :
1. Save the patient life
2. improve the heart functions
3. Relive from symptoms

20. Treatment that are administered for cardiac
tamponade include:
1. IV fluids to maintain normal BP
2. Antibiotics
3. Supplemental oxygen to reduce work load on the heart

21. PERICARDIOCENTESIS

22. PERICARDIOCENTESIS
• Pericardiocentesis, also called a pericardial tap, is a surgical
invasive procedure ( use both diagnostic and therapeutic purpose)
in which abnormal or excessive fluid is removed from the
pericardium sac the sac around your heart. Or
• Pericardiocentesis is the removal by needle of pericardial fluid
from the sac surrounding the heart for diagnostic or therapeutic
purposes.

23. PERICARDIOCENTESIS
• REMOVAL OF 5 TO 10 ML MAY DRAMATIC INCREASE STROKE VOLUME AND
CARDIAC OUTPUT BY 25 TO 50% AND REASSESS FOR IMPROVEMENT
REPEATED WHEN IT NECESSARY.

24. PURPOSE OF PERICARDIOCENTESIS
• Pericarditis (Caused By Infection, Inflammation)
• Trauma (Producing Blood In The Pericardial Sac)
• Surgery Or Other Invasive Procedures Performed On The
Heart Cancer (Producing Malignant Effusions) Myocardial
Infarction,
• Congestive Heart Failure
• Renal Failure

25. PRECAUTIONS TO PERFORM PROCEDURE
• Whenever Possible, An Echocardiogram (Ultrasound Test)
Should Be Performed To Confirm The Presence Of The
Pericardial Effusion And To Guide The Pericardiocentesis
Needle During The Procedure.
• Because Of The Risk Of Accidental Puncture To Major Arteries
Or Organs In Pericardiocentesis, Surgical Drainage May Be A
Preferred Treatment Option For Pericardial Effusion In Non-
emergency Situations.

26. COMPLICATIONS OF PERICARDIOCENTESIS
• Cardiac Arrest
• Myocardial Infarction Or Heart Attack
• Abnormal Heart Rhythms ( Arrthymias )
• Laceration Of The Heart Muscle

27. • Puncture Or Rupture Of Coronary Arteries
• Lacerations Of Organs
• Hemothorax, Penumothorax And
• Pnemuo Pericardium

28. NURSING MANAGEMENT
ACUTE CARE MANAGEMENT:
1. Assess The Client Status
2. Monitor Hemodynamic ( Pulse ,HR,BP,RR)
3. Assess Neurologic Status ( Loc ,Orientation) Confusion ,
Restlessness And Anxiety.
4. Provide Psychological Support
5. Cardiovascular Assessment ( HR JVD HS Skin Color Etc)

29. NURSING DIAGNOSIS
1. DECREASED CARDIAC OUTPUT RELATED TO REDUCED
VENTRICULAR FILLING SECONDARY TO INCREASED
INTRAPERICARDIAL PRESSURE.
INTERVENTIONS:
1.CONTINUOUSLY MONITOR ECG FOR DYSRHYTHMIA FORMATION,
WHICH MAY RESULT OF MYOCARDIAL ISCHEMIA SECONDARY TO
EPICARDIAL CORONARY ARTERY COMPRESSION.
2. MONITOR THE BP EVERY 5 TO 15 MINUTES DURING THE ACUTE
PHASE.

30. INTERVENTIONS:
3. MONITOR FOR PULSUS PARADOXUS VIA ARTERIAL
TRACING OR DURING MANUAL BP READING.
4. MONITOR URINE OUTPUT HOURLY; A DROP IN URINE
OUTPUT MAY INDICATE DECREASED RENAL PERFUSION
AS A RESULT OF DECREASED STROKE VOLUME
SECONDARY TO CARDIAC COMPRESSION.

31. • Assess Cardiovascular Status: Monitor For Jugular Vein
Distention And Presence Of Kussmaul’s Sign.
• Note Skin Temperature, Color, And Capillary Refill.
• Assess Amplitude Of Femoral Pulse During Quiet Breathing.
• Assess Level Of Consciousness For Changes That May
Indicate Decrease Cerebral Perfusion.

32. • Provide Supplemental Oxygen As Ordered.
• Initiate Two Large-bore Intravenous Lines For Fluid Administration
To Maintain Filling Pressure.
• Pharmacologic Therapy May Include Dobutamine To Enhance
Myocardial Contractility And Decrease Peripheral
Vascularresistance.
• Monitor The Patient For Dysrhythmias, Coronary Artery Laceratio.
• Surgical Intervention To Identify And Repair Bleeding Site, To
Evacuate Clots In The Mediastinum, To Resects Or Open The
Pericardium.