Detecting Early Signs of Extrapericardial Cardiac Tamponade With ECG

Cardiac tamponade is a condition with impaired cardiac function by acute fluid accumulation in the pericardium. Extracardiac masses, such as a mediastinal hematoma, can also cause cardiac tamponade. We report a case of impending extrapericardial cardiac tamponade secondary to traumatic sternal fracture with expanding mediastinal hematoma. An 82-year-old male presented to the emergency department after a motor vehicle accident. On arrival, he was hemodynamically stable. An electrocardiogram (ECG) revealed normal sinus rhythm and sporadic premature ventricular complexes (PVCs), which had been documented in his past Holter ECGs. Initial evaluation with a focused sonographic assessment for trauma was negative. However, subsequent computed tomography (CT) showed a small retrosternal hematoma with a sternal fracture and a rib fracture. On day 4, repeated ECG demonstrated more frequent PVCs, a change in morphology, and episodes of non-sustained ventricular tachycardia. Follow-up CT and echocardiogram showed an expanding hematoma and compressed right ventricle. Cardiology and Surgery were consulted, and urgent surgical drainage of the hematoma was performed. The patient was discharged without complications on day 17. An expanding mediastinal hematoma after blunt chest trauma can cause extrapericardial tamponade. In this case, the hematoma caused a change in ECG and increased ventricular ectopy, which served as a critical indicator for successful surgical intervention before circulatory collapse occurred. Telemetry and repeat ECGs should be performed for the first few days following significant chest trauma. This case highlights the utility of continuous ECG monitoring, which provides clinicians with timely recognition of cardiac functional changes and a beneficial indication for appropriate intervention.