Cardiac Tamponade: Comprehensive Analysis of a Patient Case Study

This assignment analyzes a case study of a 40-year-old female, Martha Myles, who presented to the emergency department following a high-speed car crash. The analysis focuses on the development of cardiac tamponade, a critical condition caused by the accumulation of pericardial fluid. The assignment describes the pathophysiology, causes, and clinical manifestations of cardiac tamponade, including symptoms like chest pain, shortness of breath, and the classic Beck’s triad. It emphasizes the importance of rapid diagnosis and intervention due to the potential for rapid deterioration, shock, and death. The document also highlights the nursing considerations and the urgency required in managing patients with this condition. The case study underscores the challenges in diagnosing tamponade and the need for prompt treatment in an emergency setting.

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Answer 4b
It is established that cardiac tamponade develops due to accumulation of pericardial fluid which
collects due to many causes. These causes include hemorrhage, autoimmune disorders, certain
infections and many other reasons. Cardiac tamponade typically manifests the accumulation of
pericardial fluid under pressure (Hoit, 2019). In usual case, heart is surrounded by a small
quantity of fluid within the pericardium. In Martha’s case the volume of fluid was building very
fast and led to compression of the heart chambers and tamponade occurs rapidly with much
smaller volumes. Under this pressure, the chambers of the heart are unable to relax leading to
decreased venous return, filling and cardiac output. Slow growing effusions lead to the
pericardial stretching, and effusions grow quite big (Bari, Érces, Varga, Szűcs, & Bogáts, 2018).
The cardiac filling is obstructed by an external force in cardiac tamponade. It is observed that the
normal pericardium can stretch to adapt to the physiologic alterations in the cardiac volume. But
when the reserve volume of pericardium is surpassed, it stiffens noticeably. Ventricular
interaction or interdependence increase hugely during cardiac tamponade in which the
hemodynamics of the both the chambers of heart get directly affected by each other in a larger
extent than usual. When the pericardial fluid is accumulated slowly, patients can tolerate in an
improved way rather than when it is accumulated rapidly.
Many patients with cardiac tamponade may present with symptoms which may imitate other
conditions such as shock. Patients present with indefinite symptoms like pain in chest,
palpitations, shortness of breath, or in more severe cases, dizziness, syncope and altered mental
status. They may also present in a pulseless electrical activity cardiac arrest. The classic physical

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findings in cardiac tamponade included in Beck’s triad are hypotension, jugular venous
distension, and muffled heart sounds. Pulses paradoxus that is indicated by a reduction of
systolic blood pressure by over 10 mm Hg during inspiration is one of the significant symptom
of the tamponade as it indicates pericardial effusion is the cause of tamponade. When heart is
compressed by the fluid and filling is impaired, the interventricular septum bows toward the left
ventricle at the time of inspiration because of elevated venous return to heart’s right side. It
reduces filling of the left ventricle resulting in reduced left ventricular preload and stroke
volume. So, establishing the diagnosis of tamponade is a challenging task when only clinical
signs are there as they are non-sensitive and non-specific (Stashko & Meer, 2018).
It is considered as a surgical emergency and it would be essential to present Martha to the
emergency department. Nurse must be quick while dealing with the patient of cardiac tamponade
as time is the most crucial factor as the cardiac tamponade may quickly result in hypotension,
shock, and death (Honasoge & Dubbs, 2018).
Reference
BIBLIOGRAPHY Bari, Érces, Varga, Szűcs, & Bogáts. (2018). Pathophysiology, clinical and experimental
possibilities of pericardial tamponade. Orv Hetil, 159(5), 163-7.
Hoit, B. D. (2019, September). Cardiac tamponade. Retrieved from
https://www.uptodate.com/contents/cardiac-tamponade
Honasoge, & Dubbs. (2018). Pericardial Effusion and Tamponade. Emerg. Med, 36(3), 557-65.
Stashko, E., & Meer, J. M. (2018). Cardiac Tamponade. StatPearls Publishing.

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