Cardiac tamponade

1. CARDIAC TAMPONADE PRESENTED BY SARABJIT KAUR MSc Nursing 1 st year

2. INCIDENCE CARDIAC TAMPONADE occurs in about 2 out of 10,000 people

3. DEFINATION Cardiac tamponade is a life threatening complication caused by accumulation 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 Kussmaul’s 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 with acute 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 major determinant 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 of structures 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 heart’s 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 tamponade include: 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 (<30 mm Hg) Hypotension Neurologic Anxiety Confusion Obtunded if decompression is advanced

18. CONT………… Cardiovascular Jugular vein distention Reflex tachycardia Muffled, distant heart sounds Skin Cool Pale May be clammy

19. NURSING DIAGNOSIS Ineffective Breathing Pattern related to: hyperventilation Goal: Patterns breath effectively as evidenced by no tachypnea, vital signs are within normal ranges NURSING INTERVENTIONS- Monitor strictly vital signs, especially respiratory frequency. Monitor the contents breathing, chest expansion, regularity of breathing, mouth breathing and muscle use a respirator..

20. CONT…… Give the semi-Fowler position if not contraindicated. Rationale: Facilitates lung expansion Teach clients a deep breath. Rationale: With the deep breathing exercise can increase oxygen intake. Give oxygen as indicated. Rationale: Oxygen adequate to avoid the risk of tissue damage. Give medication as indicated. Rationale: Medications that can affect the respiratory ventilation.

21. CONT………. Monitor for pulsus paradoxus via arterial tracing or during manual BP reading. 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.

22. CONT……. Decreased cardiac output related to reduced ventricularfilling secondary to increased intrapericardial pressure. GOALS-To maintain cardiac output of the patient as evidenced by client HR,BP,Pulse pressure NURSING INTERVENTIONS- Continuously monitor ECG for dysrhythmia formation, which may result of myocardial ischemia secondary to epicardial coronary artery compression. Monitor the BP every 5 to 15 minutes during the acute phase.

23. CONT…………. . 3. Note the color , presence / quality of the pulse. 4. Auscultation of breath sounds and heart sounds. Listen to the murmur. 5. Maintain bedrest in a comfortable position during the acute period. 6. Provide adequate rest periods / adequate. Assess the form of self-care activities, if indicated.

24. CONT…………… 7. Assess signs and symptoms of CHF. Activity intolerance related to restlessness, fatigue GOAL-To increase the ability of Client to perform activities of daily routine Assess the ability of client to perform activities of daily life. Assess patient’s need for assistive devices. Assess the degree of ability performed by client

25. CONT…………… Assess the degree of ability performed by client Help the people closest to identify the risk of hazards that may arise. Minimize the sources of the hazards in the environment. Deficient knowledge related to disease condition GOALS – To increase knowledge of the patient Assess the level of knowledge of the patient

26. CONT…………… Educate the patient about the disease condition Educate the patient about the treatment Educate the patient about the pericardiocentesis Encourage the patient to ask questions

27. BIBLIOGRAPHY BLACK M. JOYCE, Medical Surgical Nursing, published by Elsevier, Edition 8 th ,volume -2,page no.1406 Brunner and Suddarth’s,Textbook of medical surgical nursing, published by Lippincott Williams and Wilkins, Edition 11 th ,volume 1,page no. 854 Smeltzer C. Suzane,,Textbook of medical surgical nursing, published by Lippincott ,Edition 9, page no. 789 http ://www.etsu.edu.com