eMedicine Specialties > Cardiology > Pericardial Disease

Cardiac Tamponade: Follow-up

Author: Chakri Yarlagadda, MD, FACC, FASNC, FSCAI, Director, Noninvasive Cardiology, St Joseph Health Center, Warren, OH
Contributor Information and Disclosures

Updated: Dec 22, 2009

Follow-up

Further Inpatient Care

  • After pericardiocentesis, leave the intrapericardial catheter in place after securing it to the skin using sterile procedure and attaching it to a closed drainage system via a 3-way stopcock. Periodically check for reaccumulation of fluid, and drain as needed. The catheter can be left in place for 1-2 days and can be used for pericardiocentesis. Serial fluid cell counts can be useful for helping discover an impending bacterial catheter infection, which could be catastrophic. If the WBC count rises significantly, the pericardial catheter must be removed immediately.
  • A Swan-Ganz catheter can be left in place for continuous monitoring of hemodynamics and to assess the effect of reaccumulation of pericardial fluid.
  • A repeat echocardiogram should be performed within 24 hours.
  • A repeat chest radiograph should be performed within 24 hours.

Further Outpatient Care

A follow-up echocardiogram and chest radiograph should be performed at a monthly follow-up examination to check for recurrent fluid accumulation.

Complications

  • Pulmonary edema
  • Shock
  • Death

Prognosis

Prognosis depends on prompt recognition and management of the condition and the underlying cause of the tamponade.

Miscellaneous

Medicolegal Pitfalls

  • Be aware of clinical conditions that may simulate tamponade or pericardial effusion on 2-dimensional echocardiography findings.
  • Pulsus paradoxus may be absent in patients with low-pressure tamponade, right heart tamponade, or atrial septal defects.
  • Pulsus paradoxus can be observed in patients with nontamponade conditions involving labored breathing (eg, asthma, severe chronic obstructive pulmonary disease) and in those with right ventricular infarction.
  • Tension pneumothorax may clinically simulate cardiac tamponade.
  • Early diagnosis with a high index of suspicion is necessary to minimize the morbidity and mortality from tamponade.
 


More on Cardiac Tamponade

Overview: Cardiac Tamponade
Differential Diagnoses & Workup: Cardiac Tamponade
Treatment & Medication: Cardiac Tamponade
Follow-up: Cardiac Tamponade
Multimedia: Cardiac Tamponade
References
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Further Reading

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Keywords

cardiac tamponade, tamponade, pericardial effusion, pericardial tamponade, ventricular filling, effusive-constrictive pericarditis, constrictive pericarditis, restrictive cardiomyopathy, hemodynamic compromise, pericarditis, Dressler syndrome

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Contributor Information and Disclosures

Author

Chakri Yarlagadda, MD, FACC, FASNC, FSCAI, Director, Noninvasive Cardiology, St Joseph Health Center, Warren, OH
Chakri Yarlagadda, MD, FACC, FASNC, FSCAI is a member of the following medical societies: American College of Cardiology, American Society of Echocardiography, American Society of Nuclear Cardiology, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Medical Editor

Russell F Kelly, MD, Program Director, Assistant Professor, Department of Internal Medicine, Division of Cardiology, Cook County Hospital, Rush Medical College
Russell F Kelly, MD is a member of the following medical societies: American College of Cardiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ronald J Oudiz, MD, FACP, FACC, Associate Professor of Medicine, Division of Cardiology, The David Geffen School of Medicine at UCLA; Director, Liu Center for Pulmonary Hypertension, LA Biomedical Research Institute at Harbor-UCLA Medical Center
Ronald J Oudiz, MD, FACP, FACC is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physicians, American Heart Association, and American Thoracic Society
Disclosure: Actelion Grant/research funds Clinical Trials + honoraria; Encysive Grant/research funds Clinical Trials + honoraria; Gilead Grant/research funds Clinical Trials + honoraria; Pfizer Grant/research funds Clinical Trials + honoraria; United Therapeutics Grant/research funds Clinical Trials + honoraria; Lilly Grant/research funds Clinical Trials + honoraria; LungRx  Clinical Trials + honoraria

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

George A Stouffer III, MD, Henry A Foscue Distinguished Professor of Medicine and Cardiology, Director of Interventional Cardiology, Cardiac Catheterization Laboratory, Chief of Clinical Cardiology, Division of Cardiology, University of North Carolina Medical Center
George A Stouffer III, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, Phi Beta Kappa, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

 
 
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