Mnemonic for cardiac tamponade

What is cardiac tamponade?

Before we discuss the mnemonic for cardiac tamponade first lets talk about cardiac tamponade that what is cardiac tamponade and what causes the cardiac tamponade?

Introduction to Cardiac tamponade

Cardiac tamponade presents as a spectrum of hemodynamic abnormalities of varying severity rather than as an all-or-none phenomenon . Symptoms of large pericardial effusions reflect compression of adjacent anatomic structures, specifically the esophagus, trachea, and lung. In this situation, common symptoms include anorexia, dyspnea, cough, and chest pain. Symptoms such as dysphagia, hiccups, and hoarseness may indicate higher pressure on the adjacent tissues.

Findings that suggests cardiac tamponade

Two important physical signs of cardiac tamponade and constrictive pericarditis were described by Dr. Adolf Kussmaul in 1873. Kussmaul sign is distention of the jugular veins during inspiration. Pulsus paradoxus was described by Kussmaul as “a pulse simultaneously slight and irregular, disappearing during inspiration and returning on expiration.” The modern definition of pulsus paradoxus is a decrease in systolic blood pressure of more than 10 mm Hg during inspiration. 

This hemodynamic change reflects selective impairment of diastolic filling of the left ventricle. Pulsus paradoxus is observed in approximately 75% of patients with acute cardiac tamponade but in only about 30% of patients with chronic pericardial  effusion. Kussmaul sign and pulsus paradoxus both reflect the dyssynchrony or opposing responses of the right and left ventricles to filling during the respiratory cycle. Another term for this is ventricular discordance.

What is beck's triad?

Beck’s triad consists of distant heart sounds, increased jugular venous pressure, and hypotension. Beck’s triad is observed in one-third of patients with acute cardiac tamponade. Another triad consisting of quiet heart sounds, increased central venous pressure (CVP), and ascites has been described in patients with chronic pericardial effusion. More commonly, symptomatic patients with chronic pericardial effusion exhibit sinus tachycardia, jugular venous distention, hepatomegaly, and peripheral edema. 

Ewart sign, in which there is an area of bronchial breath sounds and dullness to percussion, is an uncommon sign of pericardial effusion. It is caused by compression of the left lower lobe by the pericardial effusion. When this sign is present it is observed at the inferior angle of the left scapula.

Signs and symptoms of cardiac tamponade

Depending on the severity of cardiac tamponade, systemic blood pressure may be decreased or maintained in the normal range. CVP is almost always increased. 

The sympathetic nervous system is activated in an attempt to maintain cardiac output and blood pressure by tachycardia and peripheral vasoconstriction. Cardiac output is maintained as long as CVP exceeds right ventricular end-diastolic pressure. A progressive increase in intrapericardial pressure, however, eventually results in equalization of right atrial pressure and right ventricular end-diastolic pressure. 

Ultimately the increased intrapericardial pressure leads to impaired diastolic filling of the heart, decreased stroke volume, and hypotension demonstrates the effects of mechanical ventilation on hemodynamics in patients with cardiac tamponade. Changes in right and left ventricular preload/volume are reversed compared to spontaneous ventilation.

Causes of cardiac tamponade 

Cardiac tamponade may be the cause of a low cardiac output syndrome during the early postoperative period after cardiac surgery. Cardiac tamponade may occur as a complication of various invasive procedures in the cardiac catheterization laboratory and intensive care unit. Acute cardiac tamponade may also be due to hemopericardium caused by aortic dissection, penetrating cardiac trauma, or acute MI. 

Mnemonic for cardiac tamponade (beck's triad)

Now we are finally going to disccus the mnemonic for cardiac tamponade beck's triad, so actualy as we have already disucessd above that becks triad composed distant heart sounds, increased jugular venous pressure, and hypotension

so the mnemonic for the becks triad is like we have to remember 3Ds

Distant heart sounds

Distended jugular vein

Decreased arterial pressure