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    Cardiac tamponade

    Tamponade; Pericardial tamponade

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

    Causes

    In this condition, blood or fluid collects in the pericardium, the sac surrounding the heart. This prevents theheartventriclesfrom expanding fully. The excess pressure from the fluid prevents the heart from functioning normally. As a result, the body does not receive enough blood.

    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 possible causes include:

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

    Cardiac tamponade occurs inabout 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
    • Weak or absent pulse

    Exams and Tests

    There are no specific laboratory tests that diagnose tamponade. Echocardiogram is typically used to help establish the diagnosis. In emergency cases, echocardiogram is done at the bedside.

    Signs:

    • Blood pressure may fall (pulsus paradoxical) when the person breathes in 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
    • Patient may look ill and frightened
    • 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 as quickly as possible. 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 tamponade must be identified and treated.

    Outlook (Prognosis)

    Cardiac tamponade is a medical emergency. If the fluid or blood is not quickly removed from the pericardium, death can occur quickly.

    The outcome is often good if the condition is treated promptly, but tamponade may come back.

    Possible Complications

    • Heart failure
    • Pulmonary edema
    • Shock
    • Death

    When to Contact a Medical Professional

    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

    LeWinter MM, Tischler MD. Pericardial diseases. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadlephia, Pa: Saunders Elsevier; 2011:chap 75.

    Little WC, Oh JK. Pericardial diseases. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 77.

    Harper RJ. Pericardiocentesis. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 16.

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    • Heart, front view

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    • Pericardium

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    • Cardiac tamponade

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      • Heart, front view

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      • Pericardium

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      • Cardiac tamponade

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      A Closer Look

        Talking to your MD

          Self Care

            Tests for Cardiac tamponade

            Review Date: 5/14/2012

            Reviewed By: Previously reviewed by Shabir Bhimji, MD, PhD, Specializing in Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. David Zieve, MD, MHA, Medical Director, A.D.A.M., Health Solutions, Ebix, Inc.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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