What causes cardiac tamponade?

Amir March 21, 2023

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When this happens, the heart does not pump blood, and as a result, not enough blood reaches other parts of the body, which can lead to organ failure, shock, and even death. Finally, in cardiac tamponade, lack of blood to the heart and other parts of the body can lead to shock, organ failure, and cardiac arrest.

The normal amount of intrapericardial fluid between 15 until the 50 ml and the pressure inside it Zero until the Three mm of mercury is less than the atmospheric pressure and due to the increase of the pressure inside the pericardial space due to the accumulation of fluid to the extent that it causes heart activity disorder, Cardiac tamponade Called . Gathering fast and sudden 100 to 200 ml of fluid inside the pericardial space can increase the pressure up to 20-30 mm Hg and as a result cardiac tamponade. But if the accumulation of fluid is chronic and occurs for a long time, even the accumulation of 1500-1000 ml of fluid may not cause tamponade.

The most common causes of tamponade are:

neoplasia
Idiopathic or viral pericarditis
Orme
Invasive actions of the heart (especially cardiac catheterization, placing a pacemaker inside the heart)
Free ventricular wall rupture after MI (the most common cause in CCU)
Bacterial infections and tuberculosis

Clinical protests :

Main board:

Lower blood pressure
Increased central venous pressure (CVP)
small and quiet heart triad Beck )

Depending on the course of the disease, its manifestations are somewhat different. In acute and severe cases, syncope and shock are the main signs, and in milder cases, the disease manifests itself with restlessness, weakness and lethargy, tachypnea, heart palpitations, cold extremities, and sometimes shortness of breath and chest pain. Chronic cases of the disease usually manifest with signs and symptoms of heart failure. so that the evidence of right ventricular failure is more obvious than left ventricular failure and therefore its main table is as peripheral edema , ascites , Hepatomegaly and signs and symptoms of decreased cardiac output (weakness and lethargy). generally , Increased central venous pressure (CVP) , relatively clean lung , Weak heart sounds And The pulse of paradox The main symptoms are pericardial tamponade.

Increased central venous pressure (CVP): In cases where there is no limitation in the expansion of the atrium and right ventricle, the central venous pressure decreases during expiration and is clinically characterized by jugular vein collapse. But in compressive pericarditis and sometimes tamponade, CVP not only does not decrease but may increase (jugular vein dilatation), which is called Kusmal’s sign (Kussmal’s Sing) is called. Kussmal’s Sing Paradox pulse (Pulses Paradoxus): In a normal state, the systolic blood pressure (S BP) decreases during inspiration, which is usually less than 10 mmHg. Paradox pulse is defined when this drop in blood pressure during inspiration is more than 10-20 mmHg. To determine the presence of paradoxical pulse, the best method is the direct measurement of arterial blood pressure. But in the clinic, it can be detected by using a normal sphygmomanometer. For this, first, the sphygmomanometer is tied around the patient’s arm, and then it is inflated to 20 mmHg above S BP. Then the pressure is gradually lowered until the first Kortkov sound is audible only during exhalation. At this level, the blood pressure is recorded and the pressure decreases gradually and slowly until the first sound of Kortkov is heard both in inhalation and exhalation. The difference of this point of pressure from the previous pressure will be the paradoxical pulse rate.