1. Cardiac Tamponade Prepared By Prepared By Dr. Hanan Said Ali Dr. Hanan Said Ali

2. Learning Objectives Define cardiac tamponade. Identify causes of cardiac tamponade. Enumerate signs and symptoms of disease. Explain how to diagnose the case. Discus the Principles of care.

3. Cardiac Tamponade Definition It is a result o accumulation of excess pericardial fluid that compress the heart. It is causing decreased cardiac filling, which leads to reduced cardiac output and shock.

4. Cardiac Tamponade Bleeding into the pericardial sac or small pericardial rupture may or may not cause cardiac tamponade, depending on the amount of pressure in the pericardium.

5. Cardiac Tamponade The pericardial sac normally holds about 25 ml of fluid, which serves to cushion and protect the heart. Only a small amount of pericardial blood ( 50 to 100 ml is necessary to increase intrapericardial pressure.

6. Cardiac Tamponade Continued bleeding increases the pressure rapidly and the patient present with signs of cardiac tamponade.

7. Cardiac Tamponade Signs and Symptoms Decreased blood pressure. abnormal heart sounds. Increased central venous pressure. Distended neck veins during inspiration pulsus paradoxus (inspiratory decrease in arterial blood pressure of more than 10 mm Hg from baseline)

8. Cardiac Tamponade ankle or sacral edema; edema; ascites; hepatosplenomegaly. The patient may complain of dyspnea, cough, and retrosternal pain that is relieved by leaning forward A patient with a large effusion experiences epigastric pain, hiccups, hoarseness, nausea, and vomiting.

9. Cardiac Tamponade Diagnostic Studies. A chest film is used to determine the presence of cardiac enlargement, mediastinal widening. The electrocardiogram (ECG) may show nonspecific abnormalities, including ST segment elevations, and T- wave changes. Echocardiography. Catheterization of the right side of the heart reveals pericardial tamponade.

10. Cardiac Tamponade Nursing care Place the patient in Trendelenburg’ position, notify the physician. Administer oxygen as ordered. Prepare the patient for Pericardiocentesis. Emergency Pericardiocentesis is life saving. Removal of 50 to 100 ml of fluid can bring major hemodynamic improvement.

11. Cardiac Tamponade Nursing care If a pericardial catheter is present, aspirate pericardial fluid, per orders. Give fluids to increase preload ( The amount of cardiac muscle fibres tension or stretch that existing at diastole, just before ventricular contraction). Discontinue agents that decrease preload ( diuretic, nitrates, morphine) ( diuretic, nitrates, morphine)