1.PRESENTED BY SARABJIT KAUR MSc Nursing 1st year

2. INCIDENCE CARDIAC TAMPONADE occurs in about 2 out of10,000 people 3. DEFINATION Cardiac tamponade is a life threatening complication caused byaccumulation of fluid in the pericardium 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 and out of the ventricles. This a cardiac emergency. 4. Causes In this condition, blood or fluid collects in the pericardium, the sac surrounding the heart. This prevents the heart ventricles from expanding fully. The excess pressure from the fluid prevents the heart from functioning normally. As a result, the body does not receive enough blood. Cardiac tamponade can occur due to: Dissecting aortic aneurysm (thoracic) End-stage lung cancer Heart attack (acute MI) Heart surgery Pericarditis caused by bacterial or viral infections Wounds to the heart 5. Other possible causes include: Heart tumors Hypothyroidism Kidney failure Leukemia Placement of central lines Radiation therapy to the chest Recent invasive heart procedures Recent open heart surgery Systemic lupus erythematosus 6. SYMPTOMS Elevated venous pressure {increased venous pressure} Distended neck veins Kussmauls sign{distended neck veins} Hypotension Tachycardia Narrow pulse pressure 7. SYMPTOMS CONT. Dyspnoea Cyanosis of lips and nails Restlessness and anxiety Diaphoresis Muffled heart sounds 8. SYMPTOMS Pulsus paradoxus Decreased friction rub Decreased QRS voltage 9. Beck's triad (cardiology) Beck's triad is a collection of three medical signs associated withacute cardiac tamponade, an emergency condition wherein fluid accumulates around the heart and impairs its ability to pump blood. The signs are low arterial blood pressure, distended neck veins, and distant, muffled heart sounds.[1] 10. Physiology The fall in arterial blood pressure results from pericardial fluid accumulation to a degree that it impairs ventricular stretch, thus reducing stroke volume, a majordeterminant of systolic blood pressure. The rising central venous pressure is evidenced by distended jugular veins while in a non-supine position. It is caused by reduced diastolic filling of the right ventricle, due to pressure from the adjacent expanding pericardial sac. This results in a backup of fluid into the veins draining into the heart, most notably, the jugular veins 11. The suppressed heart sounds occur due to the muffling effects of the fluid surrounding the heart. 12. INVESTIGATIONS The following tests are also used for diagnosis: Echocardiogram a test that uses high-frequency sound waves(ultrasound) to examine the size, shape, and motion of the heart. This is the primary test used to diagnose and manage cardiac tamponade. Cardiac catheterization a tube-like instrument inserted into the heart through a vein or artery (usually in the arm or leg) to detect problems with the heart and its blood supply Chest x-ray a test that uses radiation to take a picture of structures inside the body, especially bones 13. CONT.. CT scan a type of x-ray that uses a computer to make pictures ofstructures inside the chest MRI scan a test that uses magnetic waves to make pictures of structures inside the chest Coronary angiography x-rays taken after a dye is injected into the arteries; allows the doctor to look for abnormalities in the arteries Electrocardiogram (ECG, EKG) a test that records the hearts activity by measuring electrical currents through the heart muscle 14. MANAGEMENT Treatments are administered to: Save the patient's life Improve heart function Relieve symptoms 15. CONT.. Treatments that are administered for cardiac tamponadeinclude: Pericardiocentesis a procedure to drain the fluid around the heart Fluids to maintain normal blood pressure Antibiotics 16. Medications to help increase blood pressure to normal levels Oxygen to reduce workload on the heart 17. ASSESSMENT Pulsus paradoxus > 10 mm Hg (hallmark) Narrowed pulse pressure (