Cardiac tamponade perforation by a catheter during cardiac or

In cardiac tamponade, a rapid rise in central venous catheterization or after cardiac

intrapericardial
surgery)
pressure impairs diastolic filling of
• MI
the heart. The rise in pressure usually results
• Uremia
from blood or fluid accumulation in the
pericardial ASSESSMENT FINDINGS

sac. • Anxiety

If fluid accumulates rapidly, this condition • Diaphoresis

is commonly fatal and necessitates emergency • Dyspnea

lifesaving measures. Slow accumulation and • Hepatomegaly

• Increased venous pressure

rise in pressure, as in pericardial effusion

associated with cancer, may not produce • Muffled heart sounds on auscultation

immediate symptoms because the fibrous wall • Narrow pulse pressure

• Jugular vein distention

of the pericardial sac can gradually stretch to

accommodate as much as 1 to 2 L of fluid. • Pallor or cyanosis

CAUSES • Pulsus paradoxus (an abnormal inspiratory

drop in systemic blood pressure greater than

• Dressler’s syndrome

• Effusion (in cancer, bacterial infections, 15 mm Hg)

tuberculosis and, rarely, acute rheumatic • Reduced arterial blood pressure

fever) • Restlessness

• Hemorrhage from nontraumatic causes • Tachycardia

(such as rupture of the heart or great vessels • Upright, leaning forward posture

or anticoagulant therapy in a client with DIAGNOSTIC TEST RESULTS

pericarditis) • Chest X-ray shows slightly widened
• Hemorrhage from trauma (such as mediastinum

gunshot or stab wounds of the chest and and cardiomegaly.

• Echocardiography records pericardial effusion • Vitamin K in warfarin-induced cardiac

with signs of right ventricular and atrial tamponade

compression. INTERVENTIONS AND RATIONALES

• ECG may reveal changes produced by If the client needs pericardiocentesis

acute pericarditis. This test rarely reveals • Explain the procedure to the client to alleviate
tamponade
anxiety.
but is useful to rule out other cardiac
• Keep a pericardial aspiration needle
disorders.
attached to a 50-ml syringe by a threeway
• Pulmonary artery catheterization detects
stopcock, an ECG machine, and an
increased right atrial pressure, right ventricular
You think the
diastolic pressure, and central venous
NCLEX creates
pressure (CVP).
pressure? In cardiac
NURSING DIAGNOSES
tamponade, excess
• Ineffective tissue perfusion:
fluid puts so much
Cardiopulmonary
pressure on me, I
• Anxiety
may need emergency
• Decreased cardiac output
treatment.
TREATMENT

• Surgery: pericardiocentesis (needle aspiration

of the pericardial cavity), surgical creation

of an opening to drain fluid, or thora cotomy

Drug therapy

• Adrenergic agent: epinephrine

• Heparin antagonist: protamine sulfate in

heparin-induced cardiac tamponade

• Inotropic agent: dopamine