What are the clinical signs and symptoms of cardiac tamponade?

What are the clinical signs and symptoms of cardiac tamponade?

Cardiac tamponade can present in a variety of different scenarios. Patients can describe malaise and weakness. Often signs of right ventricular failure and left ventricular failure are seen. The chest radiograph can show a large cardiac sil-houette. The electrocardiogram (ECG) shows low voltage in all leads with nonspecific ST-T wave changes. Electrical alternans is a hallmark of cardiac tamponade and relates to shifting of the position of the heart due to pericardial fluid.

Cardiac echocardiography reveals pericardial fluid and its impact on cardiac hemodynamics. Right atrial systolic collapse (for longer than one third of systole) and right ventricular diastolic collapse have high sensitivity and specificity for cardiac tamponade. A large prospective study demonstrated that any chamber collapse had a 92% negative predictive value but only a 58% positive predictive value. It is not uncommon to see variable ventricular septal motion with respiration as well as inferior vena cava plethora. Doppler studies in tamponade indicate respiratory varia-tion in trans-mitral and trans-tricuspid flow patterns. These are inspiratory increases in right ventricular filling accompanied by concomitant inspiratory decreases in left ventricular filling.

Beck’s triad is the other classic constellation of signs and symptoms of cardiac tamponade: distant heart sounds, hypotension, and elevated central venous pressure. Of note, the postoperative cardiac surgical patient can present with small loculated pericardial effusions that mimic tamponade physiology.

Kussmaul’s sign may also be present. This sign is present in many different forms of right ventricular failure. It is marked by an increase in central venous pressure upon inspiration that results from inability of the right heart to fill.

Signs and Symptoms of Cardiac Tamponade

·        Malaise

·        Weakness

·        Right ventricular failure: ascites, peripheral edema, prerenal azotemia, hepatomegaly, jugular vein distention

·        Left ventricular failure: orthopnea, dyspnea, hypotension, decreased urine output

·        Chest radiograph: large cardiac silhouette

·        ECG: low voltage, electrical alternans

·        Echocardiogram: pericardial fluid, right atrial systolic collapse and right ventricular diastolic collapse

·        Beck’s triad: distant heart sounds, hypotension, elevated central venous pressure

·        Kussmaul’s sign