In cardiac tamponade fluid or blood collects in the sac around the heart fast enough to squeeze it, so the heart cannot fill and its output falls. Causes include cancer, pericarditis, kidney failure, chest trauma and heart procedures, and it is fatal without prompt drainage.
Key symptoms
- Shortness of breath and fast breathing
- Chest pain or pressure
- Lightheadedness, fainting or restlessness
- Fatigue
- Sudden collapse after chest trauma
What you find on exam
- Beck's triad: low blood pressure, distended neck veins, muffled heart sounds
- Pulsus paradoxus: systolic pressure falls more than 10 mmHg on inspiration
- Fast heart rate
- Clear lungs despite breathlessness
- Cool skin and signs of shock
Tests
- Bedside echocardiogram: effusion with right heart collapse in diastole
- ECG: low voltage and electrical alternans
- Chest X-ray: large, water-bottle heart if the effusion built up slowly
- Labs for the cause: blood count, kidney function, clotting tests
Treatment basics
- Urgent pericardiocentesis guided by ultrasound
- Surgical drainage for trauma or after cardiac surgery
- IV fluids as a bridge to support filling
- Avoid diuretics, nitrates and positive-pressure ventilation when possible
- Treat the cause and watch for the fluid to come back
Red flags
- Falling blood pressure or altered mental status
- Pulseless electrical activity
- Chest trauma with distended neck veins
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Sources: NCCPA PANCE Content Blueprint; NASEMSO National Model EMS Clinical Guidelines; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.