Abstract:
Cardiac tamponade is a life-threatening emergency condition. It is an acute type of pericardial effusion in which fluid
accumulates in the intrapericardial space. This creates a mechanical pressure in the cardiac chambers which disrupts cardiac filling. (1). The common causes of pericardial effusion
resulting in tamponade are pericarditis, malignancy, acute
myocardial infarction, congestive heart failure, collagen vascular diseases, end stage renal disease, viral and bacterial infections (1). Cardiac tamponade secondary to haemopericardium is rarely seen and occurs with traumatic and non-traumatic
causes. Non-traumatic causes are less common and associated
with a number of conditions such as malignancy, infection,
uraemia or coagulopathy (2). Today, warfarin sodium is still
the most commonly used agent for anticoagulant therapy. The
risk of spontaneous bleeding in patients using warfarin is less
than 10%, whereas the risk of bleeding into the pericardial
space is less than 1% (3). Echocardiography, which is the
diagnostic test of choice, evaluates the haemodynamic consequences and guides transcutaneous drainage; CT is useful
for further workup. These methods are superior to echocardiography for anatomical information, characterisation of the
effusion, and providing information about the adjacent structures (2). The primary treatment of pericardial tamponade is
pericardiocentesis.. Echocardiography-guided pericardiocentesis has been shown to be a safe and effective method which
can be performed at the patient’s bedside (4). Isolated haemopericardium and cardiac tamponade secondary to warfarin are
seen very rare. Haemorrhagic cardiac tamponade should be
excluded in patients on warfarin with unexplained hypotension and excessive anticoagulation. Close monitoring of INR
level is very important in the management of patients, especially in the elderly receiving warfarin treatment (5).