Diagnosis and Acute Management of Cardiac Tamponade

Abstract

Cardiac tamponade is a medical and surgical emergency that requires quick recognition and treatment by the critical care provider. Tamponade results from accumulation of fluid in the pericardial space leading to equalization of pressures between the pericardial space, atria, and ventricles. This alteration in physiology causes hemodynamic changes that can range from tachycardia and hypotension to cardiovascular collapse. Diagnosis relies on a high index of suspicion and accurate interpretation and use of multiple diagnostic modalities. One of the most important tools, echocardiography, plays a vital role in the diagnosis, monitoring, and treatment of tamponade. Treatment depends on the hemodynamic stability of the patient and may include advanced cardiac life support, emergent pericardiocentesis, emergent sternotomy, or medical management. This review discusses the acute diagnosis and management of cardiac tamponade specifically related to surgical patients cared for by the critical care provider. This review contains 2 figures, 2 tables, 5 videos, and 55 references. Key words: atrial and ventricular collapse, cardiac tamponade, cardiogenic shock, critical care echocardiography, equalization of pressures, hemopericardium, pericardial effusion, pericardiocentesis, pulsus paradoxus, ventricular interdependence