Cardiac tamponade
Resuscitative Cardiac Care
Definition and pathophysiology
Cardiac tamponade is life‑threatening compression of the heart caused by fluid, blood or gas in the pericardial sac. When intrapericardial pressure exceeds intracardiac filling pressures, right‑sided filling is impaired, stroke volume falls and obstructive shock develops.
Rapid accumulation (for example haemorrhage) produces acute instability and may progress to pulseless electrical activity (PEA) arrest; slowly accumulating effusions may be large but less acutely symptomatic.
Aetiology
- Traumatic
- Penetrating chest injury (most common cause of acute haemopericardium)
- Blunt thoracic trauma
- Iatrogenic / device related
- Pacemaker / ICD lead perforation
- Transcatheter procedures (TAVI, catheter interventions)
- Post‑cardiac surgery
- Medical / non‑traumatic
- Pericarditis (infective, autoimmune, uraemic)
- Malignancy
- Anticoagulation‑related bleeding
- Other
- Aortic dissection with pericardial rupture
- Myocardial free‑wall rupture post‑MI
Recognition - clinical features
Classic features are often incomplete; maintain a high index of suspicion in any unstable patient with suspected pericardial fluid.