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Cardiac tamponade

Definition

Cardiac tamponade is compression of the heart that occurs when blood or fluid builds up in the space between the myocardium (heart muscle) and the pericardium (outer covering sac of the heart).

Alternative Names

Tamponade; Pericardial tamponade

Causes, incidence, and risk factors

In this condition, blood or fluid collects in the pericardium. This prevents the ventricles from expanding fully. The excess pressure from the fluid prevents the heart from functioning normally.

Cardiac tamponade can occur due to:

• Dissecting aortic aneurysm (thoracic)
• End-stage lung cancer
• Heart attack (acute MI)
• Heart surgery
• Pericarditis caused by bacterial or viral infections
• Wounds to the heart

Other potential causes include:

• Heart tumors
• Hypothyroidism
• Kidney failure
• Placement of central lines
• Radiation therapy to the chest
• Recent invasive heart procedures
• Recent open heart surgery
• Systemic lupus erythematosus

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

Symptoms

• Anxiety, restlessness
• Chest pain
  • Radiating to the neck, shoulder, back, or abdomen
  • Sharp, stabbing
  • Worsened by deep breathing or coughing
• Difficulty breathing
• Discomfort, sometimes relieved by sitting upright or leaning forward
• Fainting, light-headedness
• Pale, gray, or blue skin
• Palpitations
• Rapid breathing
• Swelling of the abdomen or other areas

Other symptoms that may occur with this disorder:

• Dizziness
• Drowsiness
• Low blood pressure
• Weak or absent pulse

Signs and tests

There are no specific laboratory tests that diagnose tamponade. Echocardiogram is typically used to help establish the diagnosis.

Signs:

• Blood pressure may fall (pulsus paradoxical) when the person inhales deeply
• Breathing may be rapid
• Heart rate may be over 100 (normal is 60 to 100 beats per minute)
• Heart sounds are faint during examination with a stethoscope
• Neck veins may be abnormally extended (distended) but the blood pressure may be low
• Peripheral pulses may be weak or absent

Other tests may include:

• Chest CT or MRI of chest
• Chest x-ray
• Coronary angiography
• ECG

Treatment

Cardiac tamponade is an emergency condition that requires hospitalization.

The fluid around the heart must be drained. Pericardiocentesis is a procedure that uses a needle to remove fluid from the pericardial sac, the tissue that surrounds the heart.

A procedure to cut and remove part of the pericardium (surgical pericardiectomy or pericardial window) may also be done.

Fluids are given to maintain normal blood pressure until pericardiocentesis can be performed. Medications that increase blood pressure may also help sustain the patient's life until the fluid is drained.

The patient may be given oxygen. This reduces the workload on the heart by decreasing tissue demands for blood flow.

The cause of the tamponade must be identified and treated.

Support Groups

Expectations (prognosis)

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

Complications

• Heart failure
• Pulmonary edema
• Death

Calling your health care provider

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.

Prevention

Many cases are not preventable. Awareness of your personal risk factors may allow early diagnosis and treatment.

References

Jacob R, Grimm RA. Pericardial disease. In: Carey WD, ed. Cleveland Clinic: Current Clinical Medicine. 1st ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 23.