Presenting Problems in Cardiovascular Disease

Cardiac Tamponade Treatment

Dr Aadarsh Yadav23rd February 2020

Cardiac tamponade is a cardiac emergency characterized by the accumulation of fluid around the pericardium surrounding the heart. There should be a quick diagnosis and cardiac tamponade treatment or else it will be fatal. Mainly cardiac tamponade is caused by the intra-pericardial pressure that occurs due to the speed and amount of fluid accumulation between the two layers of the pericardium.

Some other conditions that may contribute to the development of cardiac tamponade are malignancy, the final stage of renal disease, bacterial infections, bacterial infections, fungal or parasitic infections, thyroid disease. Autoimmune disease ruptured the aortic aneurysm. It can be idiopathic too. In this article, you can know about the diagnosis of cardiac tamponade, cardiac tamponade treatment, and complications

The common symptoms of pericardial or cardiac tamponade are

• Dyspnea:- shortness of breath means air hunger.
• Tachycardia:- faster heartbeat rate greater than 100 times per minute
• Tachypnea:- Rapid abnormal breathe per minute i.e more than 20 breaths per minute.

Diagnosis of cardiac tamponade

Cardiac tamponade diagnosis is usually based on the patient’s medical history and physical examination findings. Diagnosis plays an important role in cardiac tamponade treatment. Mainly it has got three signs which are commonly known as Beck’s triad. After that, you may have:

The main diagnostic tests of cardiac tamponade are

1. Echocardiogram which is an ultrasound of our heart
2. Thoracic CT scan confirms the accumulation of fluid in our chest and changes occur in our heart.
3. Magnetic resonance angiogram shows the flow of blood.
4. Cardiac tamponade ECG (Electrocardiograms) to monitor the heartbeat rate.

Cardiac tamponade treatment

As cardiac tamponade is a cardiac emergency it needs immediate hospitalization.

Cardiac tamponade treatment needs mainly two steps

Prehospital care and hospital management.

During pre-hospital care, these activities are carried out and its primary purpose is to first stabilize the patient. It mainly manages oxygen supply and monitoring the patient’s heart rate and other supportive activities.

During hospital management the process occurs are

Firstly the doctor focuses on pericardiocentesis which means the insertion of the needle through the skin into the pericardium to release the fluid and the air in the pericardium. This process is followed by procedures called thoracotomy where invades in heart to drain blood or remove blood clots if you have a penetrating wound. They may remove A part of your pericardium to assist relieve pressure on your heart. Doctors will also give various supplement treatment as patients receive oxygen, fluids, and medications to increase their blood pressure. Once the tamponade is under control and the patient’s condition stabilizes, he performs additional tests to find out the underlying cause of their condition. This was a short description of the cardiac tamponade treatment.

Now, The  cardiac tamponade treatment is described in detail way

At first, a patient needs  Prehospital care so firstly,

Prehospital care

As cardiac tamponade is a clinical Syndrome it needs a medical emergency that focuses mainly on the stability of patients and drainage of the precordial fluid around the pericardium of the heart. Mainly patients are monitored in an Intensive Care Unit (ICU) and the emergency treatment patients will need are.

1. Immediate supply of oxygen.
2. The result of cardiac output should be monitored as the adequate intravascular volume is necessary to be maintained by blood plasma dextran or isotonic sodium chloride (NaCl) solution.
3. For an increase in venous return, bed rest with leg elevation is preferred.

As a decrease in venous return may make worse signs and symptoms of the cardiac tamponade so a decrease in venous return should be avoided.

The Consultation relating to the pericardial tamponade after pericardiocentesis is

Hemodynamically stable and Hemodynamically unstable patient as Hemodynamically stable patients need to consult a cardiologist and Hemodynamically unstable patients need to consult a cardiologist and cardiothoracic surgeon

During Hospital management, Pericardiocentesis and o ko is done. pericardiocentesis which means the insertion of the needle through the skin into the pericardium to release the fluid and the air in pericardium and pericardiotomy is the surgery or incision over breastbone to access the heart done under general anesthesia in order to drain out the pericardial fluid. So, pericardiocentesis is one of the cardiac tamponade treatment.

These removals of pericardial fluid can be done in three ways they are:

1. Emergency subxiphoid percutaneous drainage:- it is an extrapleural approach which is lifesaving bedside procedure. It is performed without echocardiographic guidance which is also the safest one.  In this process, aiming toward the shoulder, near the left xiphocostal angle, a needle of 16 or 18 gauge is inserted at angle 30°- 45° to the skin. It is performed in an emergency then it has a mortality rate of 4% and the complication rate is 17%.
2. Echocardiographically-guided pericardiocentesis:- This process is a cardiac catheterization process and often carried in catheterization laboratory.  It is performed from the left intercostal space.  It is done by marking the area where the accumulation of maximum fluid takes place closest to the transducer and then measuring the distance between from. Skin to the pericardial space. To prevent neurovascular injury,  while advancing the needle, an inferior rib margin should be avoided. And 16 gauge catheter is left for continuous drainage.
3. Percutaneous balloon pericardiotomy(PBP): PBP is the process to drain out the excess pericardial fluid  using a long thin tube with a balloon attached and fluid drains

Out through tube. In this process, a needle is inserted through the chest wall and when the needle reaches pericardium, the needle is removed and replaced by a long thin tube called catheter and tube consist of a balloon at its tip.

Window or hole is created by repeated inflation of the balloon in the pericardium. When fluid drains out it improves the function of the heart.

ICU care after the pericardiocentesis or pericardiotomy

Periodically checking for the reaccumulation of fluid, and drain as needed.

the catheter is left in place for a few days and can be used for pericardiocentesis if it is needed. Several fluid cell counts are done which helps to discover an impending bacterial catheter infection, which could be catastrophic. And when white blood cell (WBC) count rises significantly, the pericardial catheter should be removed immediately.

Repeated echocardiogram and repeated chest radiograph are performed within 24 hours for monitoring the action of heart after pericardiocentesis.

Hemodynamically unstable patients need more care which is Surgical creation of a pericardial window and Sclerosing the pericardium, Pericardio-peritoneal shunt, and Pericardiectomy. This is all about cardiac tamponade treatment.

Complications of pericardiocentesis

The most serious complications include

• Death
• Injury of cardiac chambers
• Laceration of the coronary arteries
• Laceration of intercostals vessels
• Puncture of the abdominal viscera or peritoneal cavity
• Pneumothorax
• Pneumopericardium
• Ventricular arrhythmias
• Pericardial decompression syndrome

Conclusion

The most common causes of cardiac tamponade are idiopathic and malignancy. Echo-guided pericardiocentesis is shielded, and the rate of complications has remained sound despite the fact that a preeminent number of procedures have been performed on an emergency basis.  Also an immediate surgical approach should be performed for traumatic hemopericardium. Echo-guided pericardiocentesis might be first choice in course of cardiac tamponade treatment.