Cardiac tamponade revisited: a postmortem look at a cautionary case

Abstract

Cardiac tamponade is a life-threatening clinical syndrome that requires timely diagnosis. Herein, we present an instructive case of a patient who had cardiac tamponade. The condition went undiagnosed and resulted in the patient's death because almost all of the pathognomonic clinical findings of tamponade were unrecognized or not manifest. To better prepare health care professionals for similar challenges, we discuss the symptoms and clinical signs typical of cardiac tamponade, review the medical literature, and highlight current investigative methods that enable quick, efficient diagnosis and treatment.

Keywords: Adenocarcinoma/complications; cardiac tamponade/diagnosis/etiology/physiopathology/therapy; echocardiography, Doppler; heart/physiopath-ology; hemodynamic processes; pericar-diocentesis; pericardium/pathology; pericardial effusion/complications/diagnosis/etiology/therapy; pulse.

Fig. 1 Pressure–volume (strain–stress) curves in rapid and slow effusions in cardiac tamponade. A) The rapidly increasing pericardial fluid first reaches the limit of the pericardial reserve volume (the initial flat segment), then quickly exceeds the limit of parietal pericardial stretching, causing a steep rise in pressure. This rise becomes even steeper as smaller increments of fluid cause a disproportionate increase in the pericardial pressure. B) A slower rate of pericardial filling takes longer to exceed the limit of pericardial stretching, because there is more time for the pericardium to stretch and for compensatory mechanisms to become activated.