Hematologic Disorders and Anemia Q 43

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Which signs cause the nurse to suspect cardiac tamponade after a client has cardiac surgery? Select all that apply.

  

     A. Tachycardia

     B. Hypertension

     C. Increased CVP

     D. Decreased urine output

     E. Jugular vein distention

    

Correct Answers: A, C, & D

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Cardiac tamponade is a medical or traumatic emergency that happens when enough fluid accumulates in the pericardial sac compressing the heart and leading to a decrease in cardiac output and shock. The diagnosis of cardiac tamponade is a clinical diagnosis that requires prompt recognition and treatment to prevent cardiovascular collapse and cardiac arrest.

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Option A: Blood in the pericardial sac compresses the heart so the ventricles cannot fill; this leads to a rapid thready pulse. Normally, a small, physiologic amount of fluid surrounds the heart within the pericardium. When the volume of fluid builds up fast enough, the chambers of the heart are compressed, and tamponade physiology develops rapidly with much smaller volumes.

Option B: Tamponade causes hypotension and a narrowed pulse pressure. The fluid may be hemorrhagic, serosanguineous, or chylous. The underlying pathology behind cardiac tamponade is a decrease in the diastolic filling, which leads to a decreased cardiac output. One of the first compensatory signs is tachycardia to overcome the reduced output.

Option C: As the tamponade increases, pressure on the heart interferes with the ejection of blood from the left ventricle, resulting in increased pressure on the right side of the heart, and systemic circulation. Patients with cardiac tamponade present similar to patients with other forms of cardiogenic or obstructive shock. They may endorse vague symptoms of chest pain, palpitations, shortness of breath, or in more severe cases, dizziness, syncope, and altered mental status.

Option D: As the heart is more inefficient, there is a decrease in kidney perfusion and therefore urine output. When fluid compresses the heart and impairs filling, the interventricular septum bows toward the left ventricle during inspiration due to increased venous return to the right side of the heart. This further decreases the left ventricle leading to decreased left ventricular preload and stroke volume.

Option E: The increased venous pressure caused JVD. The JVP tracing may reveal an absent ‘y’ descent due to the elevated intrapericardial pressure that prevents the filling of the ventricles. The classic physical findings in cardiac tamponade included in Beck’s triad are hypotension, jugular venous distension, and muffled heart sounds.

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