Cardiac tamponade is a life-threatening emergency where fluid accumulation in the pericardium compresses the heart, preventing normal filling and reducing cardiac output to critically low levels. This condition requires immediate recognition and urgent intervention. Livasa Hospital provides 24x7 emergency management with rapid pericardiocentesis and expert critical care.

Understanding Cardiac Tamponade

The pericardium is a relatively non-distensible sac. Rapid fluid accumulation increases intrapericardial pressure, compressing the right atrium and right ventricle and impairing ventricular filling. This leads to:

• Reduced cardiac output

• Systemic hypotension

• Venous congestion

• End-organ hypoperfusion

• Cardiovascular collapse if untreated

Causes

Common causes of tamponade:

• Acute myocardial infarction – Wall rupture

• Malignancy – Metastatic pericardial involvement

• Penetrating trauma – Cardiac injury

• Aortic dissection – Rupture into pericardium

• Viral pericarditis – Severe effusion with tamponade physiology

• Renal failure – Uraemic pericarditis

• Post-operative – Bleeding into pericardium after cardiac surgery

Clinical Presentation

The triad of clinical findings:

• Elevated jugular venous pressure – Visible neck vein distension

• Hypotension – Systolic BP <90 mmHg

• Muffled heart sounds – Distant or quieter heart sounds

Additional findings:

• Tachycardia

• Pulsus paradoxus – Blood pressure drop >10 mmHg with inspiration

• Altered consciousness – From cerebral hypoperfusion

• Cool extremities – From peripheral vasoconstriction

Emergency Diagnostic Evaluation

Chest X-ray:

• "Water bottle heart" appearance

• Enlarged cardiac silhouette

ECG:

• Electrical alternans – Alternating amplitude of QRS complex

• Low voltage (overall reduced amplitude)

Echocardiography:

• Gold-standard for diagnosis confirmation

• Shows pericardial fluid

• Demonstrates right atrial/ventricular collapse (classic finding)

• Assesses haemodynamic significance

Emergency Management at Livasa Hospital

Immediate measures:

1. Rapid IV access and aggressive fluid resuscitation

2. Continuous haemodynamic monitoring

3. Oxygen therapy and mechanical ventilation if needed

4. Echocardiographic confirmation of tamponade

5. Rapid preparation for pericardiocentesis

Pericardiocentesis procedure:

1. Patient positioned supine with head elevated 45–60 degrees

2. Echocardiographic guidance for optimal access site

3. Subxiphoid approach most common

4. Needle advancement until pericardial fluid aspirated

5. Catheter placement for continued drainage if needed

6. Fluid collection for analysis

Post-drainage management:

• Haemodynamic reassessment

• Repeat echocardiography

• Monitoring for reaccumulation

• Treatment of underlying cause

Complications of Untreated Tamponade

• Cardiogenic shock – Inadequate tissue perfusion

• Acute kidney injury – From hypoperfusion

• Hepatic dysfunction – From venous congestion

• Sudden cardiac death – From cardiovascular collapse

Outcomes with Rapid Treatment

• Survival dramatically improved with prompt drainage

• Complete haemodynamic recovery typically occurs

• Underlying cause determines long-term prognosis

Why Choose Livasa Hospital?

• 24x7 emergency cardiology availability

• Rapid echocardiographic capability

• Experienced operators for pericardiocentesis

• Comprehensive ICU support

• Definitive management of underlying cause

NAP – Contact Details

Livasa Hospital Mohali
Sector 71, Sahibzada Ajit Singh Nagar (SAS Nagar)
Mohali, Punjab – 160071
Phone: +91-80788 80788 (24/7 Emergency – Critical for tamponade)
Website: www.livasahospitals.com

EMERGENCY: If experiencing sudden chest pain, severe dyspnoea, hypotension or loss of consciousness, call +91-80788 80788 immediately for emergency evaluation.