Cardiac tamponade due to right atrial rupture

Abstract

Cardiac tamponade is a cardiac emergency that requires urgent intervention. Cardiac tamponade due to penetrating cardiac injury requires urgent thoracotomy. As per the guidelines, pericardiocentesis can be done as a bridge to thoracotomy. However, no clear guidelines exist on the management of cardiac tamponade due to blunt cardiac injury. In the following case report, we propose a management plan for blunt cardiac injury in the emergency department. In the following case report, we describe a patient with a road traffic accident who had a blunt cardiac injury and had cardiac tamponade for whom we did not do emergency pericardiocentesis. Instead, we managed the patient with iv fluids and blood transfusion and the patient was taken up for immediate emergency thoracotomy. Not all cardiac tamponade requires pericardiocentesis. Cardiac tamponade due to injury to the low-pressure system can be best managed by initial resuscitation followed by emergency thoracotomy. We also propose a management plan for managing a patient with cardiac tamponade due to blunt cardiac injury when the injury can be visible in the low-pressure chambers.

Keywords: Blunt cardiac injury; cardiac; echocardiography; pericardiocentesis; right atrial rupture; serial pressure gradient measurement; tamponade; thoracotomy.

Figure 1

(a) Showing POCUS-Subcostal view. The arrow indicates the tear in the right atrium. (b) Showing POCUS-Subcostal view. The image shows a flow from right atrium into the pericardial sac at the site of rupture. (c) Shows the gradient across the pericardium and the right atrium across the rupture site

Figure 2

Shows the pressure of right atrium, right ventricle ventricle and pericardial sac and hemodynamics when rupture of low pressure system occurs

Figure 3

Graphical relationship between the amount of blood leaked into the pericardium and the pericardial pressure and the pressure gradient across the rupture site