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cardio.cardiac-tamponade.post-procedural.v1

Cardiac tamponade — post-procedural / hemopericardium / iatrogenic

cardiologyacuteadultacuteinpatienttransitionoutpatient
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Phase E variant of cardio.cardiac-tamponade.core.v1 — narrowed to post-procedural/iatrogenic/traumatic etiologies (post-PCI coronary perforation per Holmes JACC 2011, post-pacer/ICD lead perforation per Cano AJC 2010, post-AF ablation per Cappato CARE 2013, post-cardiac-surgery, post-pericardiocentesis, chest trauma). Inherits drainage + bridge regimen from parent via routing; specializes for iatrogenic-specific patterns: hyperacute physiology (small effusion can tamponade if rapid accumulation per Spodick 2003); emergent pericardiocentesis with SIMULTANEOUS cardiothoracic surgery activation (ESC 2015 §Iatrogenic); agent-specific anticoagulation reversal (protamine UFH, vit K + 4F-PCC for warfarin, idarucizumab for dabigatran per Pollack RE-VERSE AD NEJM 2017 PMID 28793172, andexanet alfa for FXa-DOACs per Connolly ANNEXA-4 NEJM 2019 PMID 30730782); colchicine AVOID immediate post-op then start day 3-5 for post-pericardiotomy prevention per COPPS-2 (PMID 25268438) + CIRCS (PMID 26315582); tranexamic acid for traumatic hemopericardium per CRASH-2 within 3h. Manifest pointer reuses cardio.cardiac-tamponade.core.v1 manifest. Design-brief pointer reuses parent (post-procedural-specific differences documented inline). Status INTEGRATED until terminology + RxNav-validated reversal-agent codes are reconciled. Authored 2026-05-14 by shard-06-cardio-acute.

Entry points (5)

  • history
    Acute hemodynamic decompensation in cath lab or EP lab during/post procedure → coronary perforation or LA/RA wall perforation (Holmes JACC 2011; Cappato CARE 2013)
    acute_decompensation_post_pci_or_ablation
  • history
    New chest pain + dyspnea + RBBB pattern hours-to-days post pacer/ICD implant → lead perforation (Cano AJC 2010)
    lead_perforation_post_pacer_icd_implant
  • history
    Post-cardiac-surgery hemodynamic decompensation in first 7d → post-cardiotomy tamponade or post-pericardiotomy syndrome (Imazio CIRCS NEJM 2015 PMID 26315582)
    post_cardiotomy_decompensation
  • history
    Penetrating chest trauma to cardiac box OR blunt sternal trauma with new dyspnea/hypotension → traumatic hemopericardium (ESC 2015 §Trauma)
    penetrating_or_blunt_chest_trauma
  • imaging
    New pericardial effusion on echo within 48h of cardiac procedure with hemodynamic concern (ESC 2015)
    echo_new_effusion_post_procedure

Required inputs (9)

  • agerequired
    demographic • used at CONTEXT
    Older patients have higher complication risk + worse outcomes (Holmes JACC 2011)
  • sbprequired
    vital • used at RED_FLAGS
    Hypotension is part of Beck triad; rapid accumulation produces tamponade at small volumes (Spodick Circulation 2003)
  • hrrequired
    vital • used at CONTEXT
    Compensatory tachycardia in tamponade physiology (ESC 2015)
  • echorequired
    imaging • used at INITIAL_WORKUP
    Definitive bedside dx — chamber collapse, IVC, swinging heart; SMALL effusion can cause tamponade if rapid accumulation (ESC 2015 Class I; Spodick Circulation 2003)
  • procedure_type_and_timingrequired
    history • used at CONTEXT
    PCI vs ablation vs lead vs surgery vs trauma — drives surgical approach + reversal strategy (ESC 2015 §Iatrogenic)
  • anticoagulant_or_antiplatelet_statusrequired
    history • used at CONTEXT
    UFH, DOAC, warfarin, DAPT — drives reversal strategy (Bhatt Circulation 2018; Pollack NEJM 2017; Connolly NEJM 2019)
  • inrrequired
    lab • used at INITIAL_WORKUP
    Coagulopathy quantification for warfarin reversal (Bhatt 2018)
  • hemoglobinrequired
    lab • used at INITIAL_WORKUP
    Hemorrhagic loss quantification + transfusion threshold (ESC 2015)
  • plateletsrequired
    lab • used at INITIAL_WORKUP
    Procedural bleeding risk + transfusion threshold; DAPT effect on platelet function (Bhatt 2018)

12-phase flow (9)

  1. 1FRAME
    Post-procedural / iatrogenic tamponade — emergent pericardiocentesis + simultaneous cardiothoracic surgery activation + anticoagulation reversal (ESC 2015 §Iatrogenic Tamponade)
    inputs: sbp
    advance: iatrogenic-context tamponade physiology suspected
  2. 2ENTRY
    Recognize acute decompensation in cath/EP/OR setting OR within first 7d post-procedure; trauma context (Spodick Circulation 2003)
    inputs: age
    advance: procedural or traumatic context confirmed
  3. 3CONTEXT
    Document procedure type, timing, anticoagulant/antiplatelet regimen, hardware (lead, valve, graft) — drives surgical approach + reversal strategy (ESC 2015)
    inputs: procedure_type_and_timing, anticoagulant_or_antiplatelet_status
    advance: iatrogenic context fully captured
  4. 4RED_FLAGS
    Obstructive shock physiology — rate of accumulation > absolute volume drives physiology (Spodick 2003); periarrest/arrest scenarios require intra-arrest pericardiocentesis as temporizing maneuver (ESC 2015)
    inputs: sbp, hr
    advance: shock recognized → emergent drainage prepared with CT surgery on standby
  5. 5INITIAL_WORKUP
    STAT echo, ECG, CXR, troponin, BMP, type & cross 4 units PRBC, coags (PT/INR, aPTT, fibrinogen, anti-Xa if DOAC suspected), CBC; angiography in cath lab if PCI-related (ESC 2015)
    inputs: echo, inr, hemoglobin, platelets
    actions: panel.cardiac, panel.coag, panel.cbc
    advance: echo confirms tamponade physiology + bleeding burden quantified
  6. 6DIFFERENTIAL
    Hemorrhagic exudate expected; rule in iatrogenic source (perforation site, lead malposition, anastomotic bleed, traumatic laceration) (Holmes JACC 2011; Cano AJC 2010; Cappato CARE 2013)
    advance: source identified or under active investigation
  7. 7TREATMENT
    Step 1 emergent pericardiocentesis (echo-guided or fluoroscopic in cath lab); Step 2 anticoagulation reversal (protamine UFH, vit K + 4F-PCC for warfarin, idarucizumab dabigatran, andexanet FXa-DOACs); Step 3 cardiothoracic surgery EARLY for persistent bleeding or large defects (ESC 2015 §Iatrogenic Tamponade; Bhatt Circulation 2018)
    inputs: sbp
    advance: drainage performed + reversal initiated + surgical disposition determined
  8. 8DISPOSITION
    CCU/ICU post-drain; cardiothoracic surgery for surgical exploration if persistent bleeding; cardiac surgery if post-cardiotomy or aortic dissection involvement (ESC 2015)
    advance: multidisciplinary disposition confirmed
  9. 9MONITORING
    Re-accumulation surveillance (echo q4-6h × 24h then q12-24h × 48h); serial Hb; coagulation correction tracking; surgical wound monitoring if exploration performed (ESC 2015 §Follow-up)
    actions: panel.pleural
    advance: bleeding controlled + no re-accumulation × 48h