Cardiac tamponade medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.

Overview

If the patient is symptomatic, and if there are signs of cardiac tamponade, urgent pericardiocentesis should be performed. Additional supportive therapy includes the administration of oxygen, fluid repletion, echocardiographic monitoring, treatment of underlying pathology, reversal of anticoagulation and monitoring.

Treatment

Pre-Hospital Care

  • There is not much pre-hospital care that can be provided other than general treatment for shock which includes intravenous fluids. [1]Rapid evacuation to a hospital equiped to perform invasive procedures is usually the more appropriate course of action.
  • Some pre-hospital providers will have facilities to provide pericardiocentesis, but this is generally futile if the patient has already suffered a cardiac arrest before arrival of the healthcare professional.

Supportive Care

Tamponade presents as a spectrum of illness. There is not much debate about the course of management in the treatment of the very sick or the asymptomatic patient with a large effusion who has no signs or symptoms of cardiac tamponade. The course of treatment is often debated in those patients with echocardiographic evidence of tamponade but no clinical findings. A prudent strategy in these cases is to observe the progression of the disease process and intervene at the onset of any evidence of compromise. Volume repletion, serial echocardiographic and clinical assessment is warranted in these cases.

  • Watchful monitoring of a patient's clinical status
  • Serial echocardiography
  • Volume repletion (saline, plasma, or blood)
  • Treatment of underlying etiology and reversal of anticoagulation
  • The role of ionotropic agents is unclear

Hospital Management

If the patient is symptomatic and has signs of cardiac tamponade the initial management in the hospital setting is by urgent pericardiocentesis. [2] This involves aspirating the fluid by inserting a needle through the skin and into the pericardium. Often, a cannula is left in place during resuscitation following initial drainage so that additional fluid can continue to drain. If there is distortion of anatomy, a small effusion, or if the effusion is loculated or located posteriorly, an emergency pericardial window may be performed instead. [3] This procedure involves cutting the pericardium open to allow the fluid to drain. Following stabilization of the patient, surgery is provided to seal the source of the bleed and mend the pericardium.

2015 ESC Guidelines on the Diagnosis and Treatment of Cardiac tamponade (DO NOT EDIT)[4]

[4]

Recommendations for the management of cardiac tamponade

Class III
1. Vasodilators and diuretics are not recommended in the presence of cardiac tamponade.(Level of Evidence: C)

References

  1. Greaves, I., Porter, K. (2007). Oxford handbook of pre-hospital care. Oxford: Oxford University Press ISBN 9780198515845
  2. Gwinnutt, C., Driscoll, P. (Eds) (2003) (2nd Ed.) Trauma Resuscitation: The Team Approach. Oxford: BIOS Scientific Publishers Ltd. ISBN 978-1859960097
  3. Gwinnutt, C., Driscoll, P. (Eds) (2003) (2nd Ed.) Trauma Resuscitation: The Team Approach. Oxford: BIOS Scientific Publishers Ltd. ISBN 978-1859960097
  4. 4.0 4.1 Adler, Yehuda; Charron, Philippe; Imazio, Massimo; Badano, Luigi; Barón-Esquivias, Gonzalo; Bogaert, Jan; Brucato, Antonio; Gueret, Pascal; Klingel, Karin; Lionis, Christos; Maisch, Bernhard; Mayosi, Bongani; Pavie, Alain; Ristić, Arsen D.; Sabaté Tenas, Manel; Seferovic, Petar; Swedberg, Karl; Tomkowski, Witold (2015). "2015 ESC Guidelines for the diagnosis and management of pericardial diseases". European Heart Journal. 36 (42): 2921–2964. doi:10.1093/eurheartj/ehv318. ISSN 0195-668X.


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