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Cardiac Tamponade

Cardiac Tamponade. Objectives. The learner will be able to: Describe cardiac tamponade and its signs and symptoms. Discuss management strategies for cardiac tamponade. Definition. Pericardial pressure > 30 mm Hg from fluid accumulation (effusion) in the pericardial sac

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Cardiac Tamponade

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  1. Cardiac Tamponade

  2. Objectives The learner will be able to: • Describe cardiac tamponadeand its signs and symptoms. • Discuss management strategies for cardiac tamponade.

  3. Definition • Pericardial pressure > 30 mm Hg from fluid accumulation (effusion) in the pericardial sac • Pressure on chambers inhibits inflow of blood to the ventricles and reduces cardiac output.

  4. Significance • Tamponade can occur with only 5080 mL of accumulation. • Untreated can lead to: • Cardiovascular collapse • Shock • Death

  5. Disease-Related Incidence • Primary malignancy • Malignant mesothelioma • Histiocytoma • Rhabdomyosarcoma • Angiosarcoma • Pericardial effusions • Present in 5%50% of all malignancies • Thoracic cancers (lung, breast, and lymphoma)

  6. Treatment-Related Incidence • History of radiation to the chest • Chemotherapy • Doxorubicin, daunorubicin, and cyclophosphamide • Biotherapy • Interferon, interleukin, and colony-stimulating factors

  7. Early Symptoms (Effusion) • Asymptomatic during “effusion” period • Often mimic heart failure • Jugular venous distention (JVD) • Peripheral edema • Hepatomegaly and abdominal distention • Increased diastolic pressure • Tachycardia • Fatigue, dyspnea, and orthopnea

  8. Late Symptoms • Dull chest pain/heaviness • Increasing dyspnea and “air hunger” • Tripod positioning • Nonproductive cough • Anxiety, agitation, and mental status changes • Cold sweats or confusion • Hiccoughs, dysphagia, or hoarse voice

  9. Physical Assessment • JVD (nonpulsating) • Weak pulses and tachycardia • Muffled heart sounds; possible friction rub • Downward, left shift of PMI • Hypotension and narrow pulse pressure • Decreased urine output (oliguria) • Pulsus paradoxus (late sign)

  10. Diagnostics • Chest x-ray • EKG changes • CT or MRI scans • Transesophogeal echocardiogram • Pericardiocentesis

  11. Treatment • Immediate removal of fluid • Pericardiocentesis • Control reaccumulation of fluid. • Permanent defect in pericardium to drain • Sclerosis of mesothelium with irritants given via catheter to prevent fluid reaccumulation

  12. Pericardiocentesis • Complications (occur in 10%25%) • Puncture of cardiac muscle or artery • Air emboli • Dysrhythmia • Infection/abscess • Vagal response and bradycardia

  13. Additional Therapies • Radiation therapy • Chemotherapy • Glucocorticoids • IV fluids • Diuretics

  14. Nursing Management • Early identification of risk and manifestation • Assist with positioning and activities. • Oxygen • Manage pain. • Manage anxiety. • Ongoing regular assessments • Prepare for procedures.

  15. References Braunwald, E. (2001). Pericardial disease. In E. Braunwald, A.S. Fauci, D.L. Kasper, S.L. Hauser, D.L. Longo, & J.L. Jameson (Eds.), Harrison’s principles of internal medicine (5th ed., pp. 13651372). New York, NY: McGraw-Hill. Flounders, J.A. (2003). Cardiovascular emergencies: Pericardial effusion and cardiac tamponade [Online exclusive]. Oncology Nursing Forum, 30, E48E55. Grannis, F.W., Wagman, L.D., Lai, L., & Curcio, L.D. (2002). Fluid complications. In R. Pazdur, L.R. Coia, W.J. Hoskins, & L.D. Wagman (Eds.), Cancer management: A multi-disciplinary approach (pp. 943958). Melville, NY: PRR. Hawley, J., Dreher, H.M., & Vasso, M. (2003). Under pressure: Treating cardiac tamponade. Nursing Management,34(2), 44D, 44F, 44H. Humphreys, M. (2003). Conditions affecting the pericardium. Connect, The World of Critical Care Nursing, 2, 8084.

  16. References (cont.) Hunter, J.C. (2005). Structural emergencies. In J.K. Itano & K.N. Taoka (Eds.), Core curriculum for oncology nurses (4th ed., pp. 442439). St. Louis, MO: Elsevier Saunders. Kaplow, R. (2005). Cardiac tamponade. In C. Yarbro, M.H. Frogge, & M. Goodman (Eds.), Cancer nursing: Principles and practice (6th ed., pp. 837886). Sudbury, MA: Jones and Bartlett. Keefe, D.L. (2000). Cardiovascular emergencies in the cancer patient. Seminars in Oncology, 27, 244255. Myers, J.S. (2001). Oncologic complications. In S.E. Otto (Ed.), Oncology nursing (4th ed., pp. 498581). St. Louis, MO: Mosby. Read, W., & Denes, A. (2002). Oncologic emergencies. In R. Govindan (Ed.), Washington manual of oncology (pp. 465466). Philadelphia, PA: Lippincott Williams and Wilkins.

  17. References (cont.) Shabetai, R. (2004). Pericardial effusion: Haemodynamic spectrum. Heart, 90, 255256. Shatzer, M., & Castor, A. (2004). How transthoracic echocardiography detects cardiac tamponade. Nursing, 34(3), 7374. Shelton, B.K. (2000). Pericarditis/pericardial effusion/cardiac tamponade. In D. Camp-Sorrell & R.A. Hawkins (Eds.), Clinical manual for the oncology advanced practice nurse (pp. 307326). Pittsburgh, PA: Oncology Nursing Society. Story, K.T. (2006). Cardiac tamponade. In M. Kaplan (Ed.), Understanding and managing oncologic emergencies: A resource for nurses (pp. 129). Pittsburgh, PA: Oncology Nursing Society.

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