Cardiac tamponade (patient information)


 * Associate Editor-In-Chief: Varun Kumar, M.B.B.S.

Overview
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). This prevents the ventricles from expanding fully. The excess pressure from the fluid prevents the heart from functioning normally.

What are the symptoms of cardiac tamponade?

 * Anxiety, restlessness
 * Chest pain- Sharp and stabbing pain which worsens with 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
 * Low blood pressure
 * Weak or absent pulse

What causes cardiac tamponade?
Cardiac tamponade can occur when fluid or blood rapidly accumulates in pericardial cavity and thereby cause elevated intrapericardial pressure. Below are few of the causes for fluid in pericardium leading to cardiac tamponade.
 * Chest trauma
 * Rupture of aortic aneurysm (thoracic)
 * End-stage lung cancer
 * Heart attack (acute MI)
 * Heart surgery
 * Pericarditis caused by bacterial or viral infections
 * Wounds to the heart
 * 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

When to seek urgent medical care?
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.

Diagnosis
Your doctor may advice the following tests:
 * Chest CT or MRI of chest
 * Chest x-ray
 * Coronary angiography
 * ECG

Treatment options
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.

What to expect (Outlook/Prognosis)
Tamponade is life-threatening if untreated. The outcome is often good if the condition is treated promptly, but tamponade may come back.

Possible complications

 * Heart failure
 * Pulmonary edema
 * Death

Videos
Below is a video demonstrating bleeding into the pericardium leading to development of cardiac tamponade. 