1. Cardiac Tamponade Dr Neeraj Aggarwal Consultant Pediatric Cardiologist
Department of Pediatric Cardiac Sciences
Sir Ganga Ram Hospital
New Delhi

2. Cardiac Tamponade
Cardiac tamponade results from an accumulation of pericardial fluid under pressure, leading to impaired cardiac filling and hemodynamic compromise.

3. Tamponade – Clinical signs
Tachycardia, Tachypnoea and hepatomegaly
Beck triad –uncommon
Raised JVP
Hypotension
Diminished heart sounds

4. Pulsus Paradoxus (or paradoxical pulse) is an exaggeration (SBP fall>10 mm Hg ) of the normal inspiratory decrease in systemic blood pressure.

5. Bottle shaped heart and absence of pulmonary vascular markings-but may not be seen in acute cases

6. Electrical alternans on ECG- beat to beat variations in QRS complex-specific but less sensitive

7. Dilated IVC ,non collapsing and distended

8. RV collapse

10. Supportive
Volume expansion with blood, plasma, dextran or isotonic sodium chloride solution, as necessary to maintain adequate intravascular volume.
Bed rest with leg elevation - This may help increase venous return
Inotropic drugs (e.g. dobutamine/Levosimendan) - increase cardiac output without increasing systemic vascular resistance

11. Pericardiocentesis Position of pt
Semi recumbent position at a 30- to 45-degree angle. This position brings the heart closer to the anterior chest wall.
The supine position is an acceptable alternative.

13.  needle at 45-degree angle to the abdominal wall and 45 degrees off the midline sagittal plane

14. APICAL APPROACH

17. Most reliable - USG guidance
Pericardial Aspirate
Intracardiac Blood
No Clotting except in tumours
Lower Hb than pts blood
Clotting of blood
Same Hb as pts blood