Cardiac tamponade

  • Definition
    • 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.

  • Alternative Names
    • Tamponade; Pericardial tamponade; Pericarditis - tamponade

  • 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:

      Other possible causes include:

      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:

  • 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
  • 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.