Alternate Names: Tamponade; Pericardial tamponade

Causes and Risks:

Cardiac tamponade may be related to pericarditis that results from bacterial or viral infections, with fluid accumulation that results from these processes. It may also be related to heart surgery, dissecting aortic aneurysm (thoracic), penetrating or blunt cardiac trauma, thoracic malignancy, and acute MI.

Blood or fluid collects within the pericardium. This prevents the ventricles from expanding fully, so they cannot adequately fill or pump blood.

Risks for cardiac tamponade include many disorders, such as pericarditis, heart tumors, kidney failure, recent heart attack, injury to the pericardium from surgery or accident, recent invasive heart procedures, radiation therapy to the chest, hypothyroidism, and systemic lupus erythematosus.

Cardiac tamponade occurs in approximately 2 out of 10,000 people.

Prevention:

Many cases are not preventable. Awareness of risk can allow early diagnosis and treatment.

Symptoms:

• Anxiety, restlessness
• Sometimes discomfort is relieved by sitting upright or leaning forward.
• Difficulty breathing
• Rapid breathing
• Fainting, lightheadedness
• Chest pain
  • Radiating to the neck, shoulder, back or abdomen
  • Sharp, stabbing
  • Worsened by deep breathing or coughing
• Swelling of the abdomen or other areas
• Skin pale, gray or blue
• Palpitations

Additional symptoms that may be associated with this disease:

• Pulse, weak or absent
• Drowsiness
• Dizziness
• Blood pressure, low

Signs and Tests:

There are no specific laboratory tests that diagnose tamponade. However, the heart will sound uncharacteristically faint during examination with a stethoscope (auscultation). Peripheral pulses may be weak or absent. Neck veins may be distended but the blood pressure may be low.

The heart rate may be over 100 (normal is 60 to 100 beats per minute), and breathing may be rapid (faster than 12 breaths in an adult per minute). The blood pressure may fall (pulsus paradoxical) when the person inhales deeply.

• Fluid in the pericardial sac may show on:
  • Chest X-ray
  • Echocardiogram
  • Chest CT or MRI of chest
  • Coronary angiography (may show other changes also)
• ECG changes include low voltage wave forms

Treatment:

Cardiac tamponade is an emergency condition that requires hospitalization. Treatment is aimed at saving the patient’s life, improving heart function, and treating of the tamponade, usually with drainage of the fluid around the heart by pericardiocentesis or emergent sternotomy (opening of the breast bone) and operative evacuation.

Fluids are the initial treatment to increase the pressure from within the myocardium (muscle of the heart) and to enable the heart to push out against the inward pressure from the surrounding pericardial fluid until pericardiocentesis can be performed. Giving medications that increase the contractility of the heart may also aid in sustaining life until the fluid is evacuated.

Oxygen reduces the workload on the heart by decreasing tissue demands for blood flow.

The cause of the tamponade must be identified and treated. Treatment of the cause may include medications such as antibiotics, and surgical repair of injury.

Removal of excess fluid from the sac (pericardiocentesis) may relieve symptoms and can be life-saving.

Cutting and/or removal of part of the pericardium (surgical pericardiectomy also known as pericardial window) may be required if scarring is a cause of tamponade.

Prognosis:

Tamponade is life threatening if untreated. The outcome is often good if the condition is treated promptly, but tamponade may recur.

Complications:

• Heart failure
• Pulmonary edema

Go to the emergency room or call the local emergency number (such as 911) if symptoms develop. Cardiac tamponade is an emergency condition requiring immediate attention!