Cardiac tamponade, also known as pericardial tamponade, is a medical emergency condition where liquid accumulates in the pericardium in a relatively short time. The elevated pericardial pressure prevents proper filling of heart cavities. Instead of reducing the filling of both ventricles equally, the septum of the heart will bend into either the left or right ventricle. The end result is low stroke volume, shock and often death. The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... A medical emergency is an injury or illness that poses an immediate threat to a persons health or life which requires help from a doctor or hospital. ... The pericardium is a double-walled sac that contains the heart and the roots of the great vessels. ... The heart and lungs, from an older edition of Grays Anatomy. ... Look up septum in Wiktionary, the free dictionary. ... In cardiovascular physiology, stroke volume (SV) is the amount of blood pumped by the left ventricle into the aorta. ... Shock is a serious medical condition where the tissue perfusion is insufficient to meet the required supply of oxygen and nutrients. ...

Causes

Cardiac tamponade occurs when the pericardial space fills up with fluid faster than the pericardial sac can stretch. If the amount of fluid increases slowly (such as in hypothyroidism) the pericardial sac can expand to contain a liter or more of fluid prior to tamponade occurring. If the fluid occurs rapidly (as may occur after trauma or myocardial rupture) as little as 100 ml can cause tamponade. Hypothyroidism is a pathologic state caused by insufficient secretion of thyroid hormones by the thyroid gland. ...

Causes of increased pericardial effusion include hypothyroidism, trauma (either penetrating trauma involving the pericardium or blunt chest trauma), pericarditis (inflammation of the pericardium), iatrogenic trauma (during an invasive procedure), and myocardial rupture. Pericarditis is inflammation of the pericardium. ...

Myocardial rupture is a somewhat uncommon cause of pericardial tamponade. It typically happens in the subacute setting after a myocardial infarction (heart attack), in which the infarcted muscle of the heart thins out and tears. Myocardial rupture is more likely to happen in elderly individuals without any previous cardiac history who suffer from their first heart attack and are not revascularized either with thrombolytic therapy or with percutaneous coronary intervention or with coronary artery bypass graft surgery. Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a disease that occurs when the blood supply to a part of the heart is interrupted. ... The heart and lungs, from an older edition of Grays Anatomy. ... Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ... Percutaneous coronary intervention is an invasive cardiologic therapeutic procedure to treat narrowed coronary arteries (artery stenosis). ... Early in a coronary artery bypass surgery during vein harvesting from the legs (left of image) and the establishment of bypass (placement of the aortic cannula) (bottom of image). ...

Diagnosis

Signs and symptoms of cardiac tamponade can appear very similar to congestive heart failure. Usually, however, the differential diagnosis can be made via a history of sudden onset attributable to trauma, particularly in younger patients. Congestive heart failure (CHF), also called congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood throughout the body. ... In medicine, differential diagnosis (sometimes abbreviated DDx or ΔΔ) is the systematic method physicians use to identify the disease causing a patients symptoms. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ...

Identification of cardiac tamponade relies upon Beck's triad: hypotension, jugular vein distension, and muffled heart sounds resulting from accumulated fluid dampening sound transmission through the chest wall. In pre-hospital settings, identification of the quiet heart sounds can be difficult. It is important to note the baseline condition during the primary survey and recognize a downward trend. Becks triad is comprised of fall in the systolic pressure, rising jugular venous pressure and suppressed heart sounds. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... Jugular vein - Wikipedia, the free encyclopedia /**/ @import /skins-1. ... Front of thorax, showing surface relations of bones, lungs (purple), pleura (blue), and heart (red outline). ...

Tension pneumothorax is the major differential diagnosis of cardiac tamponade. A tension pneumothorax will present with a deviated trachea and unequal breath sounds. Cardiac tamponade presents with a midline trachea and equal breath sounds, unless comorbid with either hemothorax or pneumothorax. A paradoxical pulse may also present in cardiac tamponade. A tension pneumothorax is a life threatening condition that results from a progressive deterioration and worsening of a simple pneumothorax, associated with the formation of a one-way valve at the point of rupture. ... Windpipe redirects here. ... Breath sounds refer to the specific sounds identified through auscultation of the respiratory system with a stethescope. ... In medicine and in psychiatry, comorbidity refers to: The presence of one or more disorders (or diseases) in addition to a primary disease or disorder. ... A hemothorax is a condition that results from blood accumulating in the pleural cavity. ... In medicine (pulmonology), a pneumothorax or collapsed lung is a medical emergency caused by the collapse of the lung within the chest cavity. ... In medicine, a pulsus paradoxus (PP), also paradoxic pulse and paradoxical pulse, is a sign that is indicative of several conditions including cardiac tamponade and obstructive lung diseases (e. ...

First Aid

If recognized, call for help and arrange for immediate transport to advanced medical care. MEDEVAC in wilderness first aid situations is indicated. If the patient's heart stops, CPR should be initiated immediately, although patient outcomes for out-of-hospital, tamponade-related arrest are extremely low. It has been suggested that this article or section be merged with Distress call. ... Airbus A310 MRT MedEvac of the German Airforce. ... Wilderness first aid is the provision of first aid under conditions where the arrival of emergency responders or the patient evacuation may be delayed due to constraints of terrain, weather, and available persons or equipment. ... Wikibooks has more about this subject: First Aid/CPR Cardiopulmonary resuscitation (CPR) is an emergency first aid protocol for a victim of cardiac arrest. ...

Pre-hospital care (for EMTs and Paramedics)

Definitive care requires in-hospital interventions. Prehospital interventions, even with Advanced Life Support-trained crews, cannot sufficiently treat the condition. Management of cardiac tamponade includes: The examples and perspective in this article or section may not represent a worldwide view. ... A paramedic is an Emergency medical technician certified to the highest level of training and responds to medical and trauma emergencies in the pre-hospital setting (in-field) for the purpose of stabilizing a patients condition before and during transportation to an appropriate medical facility, usually by ambulance. ... Advanced Life Support (ALS) is a treatment consensus for cardiopulmonary resuscitation in cardiac arrest and related medical problems, as agreed by the European Resuscitation Council, most recently in 2000. ...

• High flow oxygen either by non-rebreather mask or bag valve mask.
• Timely identification of symptoms followed by rapid transport.
• IV administration of electrolyte fluids (normal saline) to maintain a systolic blood pressure of between 90 and 100 mmHg
• Monitoring oxygen saturation and blood pressure levels
• Early activation of an Aeromedical Evacuation team or rapid transport to a designated trauma center

There is little care that can be provided prehospitally except management of the shock condition. Definitive care requires piercing the pericardial membrane with a needle permitting the fluid evacuation. Piercing the pericardial membrane with a needle (which was a skill taught in the early days of EMS to all Paramedics) is generally not advised in the back of a bouncing ambulance. In most states, Paramedics working in a ground-based ambulance may not legally perform this procedure. However many flight medics and flight nurses are trained to perform needle pericardiocentesis. Military Medics are also trained to perform this procedure. A BVM Resuscitator A BVM Resuscitator (Bag Valve Mask) is a part of the usual equipment for advanced life support patient treatment in emergencies. ... In medicine saline is a solution of sodium chloride in water. ...

Clinical treatment

Pericardiocentesis, needle evacuation of the fluid and lowering of the pericardial pressure, and then treatment of the underlying cause, is life-saving. Often, a pericardial drain is left in situ to prevent short-term recurrence. Surgery to repair the damage to the heart is often required. In medicine, pericardiocentesis is a procedure where fluid is aspirated from the pericardium (the sac enveloping the heart). ...

See also

• Tamponade
• emergency medicine

Tamponade is a condition of blood flow stoppage either by insertion of a tampon (a wadded cotton plug) into a blood vessel or by a constriction of the vessel by an outside force. ... Emergency medicine is a branch of medicine that is practiced in a hospital emergency department, in the field (in a modified form; see EMS), and other locations where initial medical treatment of illness takes place. ...

External links

• MedlinePlus Encylopedia 000194

• [1] this is a Wiki dealing with postoperative tamponade (after cardiac surgery).