March 2004 
Volume 34  Number 3
Pages 73 - 74
  PDF Version Available!


  • Understanding cardiac tamponade


    JEFFREY MOORE, 59, who's in the step-down unit recovering from transvenous pacer wire insertion, calls you into his room, complaining of difficulty breathing. Your assessment reveals a dyspneic, anxious, and diaphoretic patient with cool, clammy skin and distended neck veins.

    His vital signs are: temperature, 98° F (36.7° C); BP, 112/88; and respirations, 26. While taking an apical pulse, you note tachycardia and faint heart sounds. A stat portable chest X-ray shows an enlarged cardiac silhouette. A 12-lead ECG reveals sinus tachycardia (118 beats/minute) with nonspecific ST-segment and T-wave changes. However, you also note electrical alternans (a beat-to-beat change in the axis of the ECG that can be caused by a swinging motion of the heart during pericardial effusion).

    The cardiologist suspects cardiac tamponade—fluid accumulation in the pericardial ...

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