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Cardiac tamponade

Tamponade; Pericardial tamponade; Pericarditis - tamponade

 

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

Causes

 

In this condition, blood or fluid collects in the sac surrounding the heart. This prevents the heart ventricles from expanding fully. The excess pressure from the fluid prevents the heart from working properly. As a result, the body does not get 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
  • Underactive thyroid gland
  • Kidney failure
  • Leukemia
  • Placement of central lines
  • Radiation therapy to the chest
  • Recent invasive heart procedures
  • Systemic lupus erythematosus
  • Dematomyositis
  • Heart failure

Cardiac tamponade due to disease occurs in about 2 out of 10,000 people.

 

Symptoms

 

Symptoms may include:

  • Anxiety, restlessness
  • Sharp chest pain that is felt in the neck, shoulder, back, or abdomen
  • Chest pain that gets worse with deep breathing or coughing
  • Problems breathing
  • Discomfort, sometimes relieved by sitting upright or leaning forward
  • Fainting, lightheadedness
  • Pale, gray, or blue skin
  • Palpitations
  • Rapid breathing
  • Swelling of the legs or abdomen
  • Jaundice

Other symptoms that may occur with this disorder:

  • Dizziness
  • Drowsiness
  • Weak or absent pulse

 

Exams and Tests

 

Echocardiogram is the test of choice to help make the diagnosis. This test may be done at the bedside in emergency cases.

A physical exam may show:

  • Blood pressure that falls when breathing deeply
  • Rapid breathing
  • Heart rate over 100 (normal is 60 to 100 beats per minute)
  • Heart sounds are only faintly heard through a stethoscope
  • Neck veins that may be bulging (distended) but the blood pressure is low
  • Weak or absent peripheral pulses

Other tests may include:

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

 

Treatment

 

Cardiac tamponade is an emergency condition that needs to be treated in the hospital.

The fluid around the heart must be drained as quickly as possible. A procedure that uses a needle to remove fluid from the tissue that surrounds the heart will be done.

A surgical procedure to cut and remove part of the covering of the heart (pericardium) may also be done. This is known as surgical pericardiectomy or pericardial window.

Fluids are given to keep blood pressure normal until the fluid can be drained from around the heart. Medicines that increase blood pressure may also help keep the person alive until the fluid is drained.

Oxygen may be given to help reduce the workload on the heart by decreasing tissue demands for blood flow.

The cause of tamponade must be found and treated.

 

Outlook (Prognosis)

 

Death due to cardiac tamponade can occur quickly if the fluid or blood is not removed promptly from the pericardium.

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

 

Possible Complications

 

Complications may include:

  • Heart failure
  • Pulmonary edema
  • Bleeding
  • 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 that needs immediate medical attention.

 

Prevention

 

Many cases can't be prevented. Knowing your personal risk factors may help you get early diagnosis and treatment.

 

 

References

LeWinter MM, Hopkins WE. Pericardial diseases. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 71.

Little WC, Oh JK. Pericardial diseases. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 77.

Mallemat HA, Tewelde SZ. Pericardiocentesis. In: Roberts JR, ed. Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 16.

 
  • Heart, front view

    Heart, front view - illustration

    The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

    Heart, front view

    illustration

  • Pericardium

    Pericardium - illustration

    The pericardium is a thin double-layered sac which encloses the heart. Fluid is contained within the layers and lubricates the constantly rubbing surfaces.

    Pericardium

    illustration

  • Cardiac tamponade

    Cardiac tamponade - illustration

    Cardiac tamponade is a condition involving compression of the heart caused by blood or fluid accumulation in the space between the myocardium (the muscle of the heart) and the pericardium (the outer covering sac of the heart). Blood or fluid collects within the pericardium. This prevents the ventricles from expanding fully, so they cannot adequately fill or pump blood. Cardiac tamponade is an emergency condition that requires hospitalization.

    Cardiac tamponade

    illustration

    • Heart, front view

      Heart, front view - illustration

      The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

      Heart, front view

      illustration

    • Pericardium

      Pericardium - illustration

      The pericardium is a thin double-layered sac which encloses the heart. Fluid is contained within the layers and lubricates the constantly rubbing surfaces.

      Pericardium

      illustration

    • Cardiac tamponade

      Cardiac tamponade - illustration

      Cardiac tamponade is a condition involving compression of the heart caused by blood or fluid accumulation in the space between the myocardium (the muscle of the heart) and the pericardium (the outer covering sac of the heart). Blood or fluid collects within the pericardium. This prevents the ventricles from expanding fully, so they cannot adequately fill or pump blood. Cardiac tamponade is an emergency condition that requires hospitalization.

      Cardiac tamponade

      illustration

    Self Care

     

      Tests for Cardiac tamponade

       

         

        Review Date: 5/24/2016

        Reviewed By: Mary C. Mancini, MD, PhD, Department of Surgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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