Cardiac tamponade: Causes, symptoms, and treatment (original) (raw)

Cardiac tamponade is when fluid collects around the heart muscle, for instance, due to trauma. It puts strain on the heart and stops it working effectively. Symptoms include a drop in blood pressure and distended blood vessels. It needs urgent treatment.

In people with cardiac tamponade, also known as pericardial tamponade, fluid or blood builds up between the heart and the sac that surrounds the heart. This sac is called the pericardium.

The pericardium consists of two thin layers of tissue. This area usually contains a small amount of fluid to prevent friction between the layers.

However, an abnormally high level of fluid puts pressure on the heart and affects its ability to pump blood around the body properly. If the level of fluid builds up quickly, the condition can be life threatening.

Doctors consider cardiac tamponade to be a medical emergency.

In this article, we discuss the causes and symptoms of cardiac tamponade. We also describe the treatment options and the outlook for people with this condition.

Cardiac tamponade impairs the ability of the heart to pump blood around the body. As a result, blood does not circulate properly, which can lead to symptoms such as chest pain and lightheadedness.

The three classic signs of cardiac tamponade, which doctors refer to as Beck’s triad, are:

• low blood pressure in the arteries

• muffled heart sounds

• swollen or bulging neck veins, called distended veins

• a rapid heart rate

• fainting

• drowsiness

• anxiety

• sharp pain in the chest, back, abdomen, or shoulder

• shortness of breath

• dizziness or nearly fainting

• a weak pulse

• bluish skin that is cool to the touch

The diagnosis of cardiac tamponade requires a doctor to look for Beck’s triad of medical signs. They will do this by checking the individual’s blood pressure, listening to their heart, and examining the appearance of their veins.

The doctor is likely to carry out additional tests to support their diagnosis. These may include:

• Echocardiogram: Doctors commonly carry out an echocardiogram, or echo, if they suspect cardiac tamponade. This scan provides a detailed image of the heart, which may help the doctor detect fluid in the pericardial sac or a collapsed ventricle.
• Chest X-ray: An X-ray of the chest shows whether the heart is abnormally large or an unusual shape due to fluid buildup.
• EKG: This test allows the doctor to examine the electrical activity of the heart.
• CT scan: A CT scan of the chest can confirm the presence of extra fluid in the pericardium.

The doctor may order blood tests to measure the levels of red and white blood cells or inflammatory markers. Blood tests may also detect higher levels of specific enzymes that the body releases in response to damage to the heart muscle.

Cardiac tamponade is not a common condition, but it can affect anyone.

A 2018 study reports five cases of cardiac tamponade for every 10,000 hospital admissions — equating to 0.05% — in the United States.

People with certain medical conditions are more likely than the general population to experience cardiac tamponade. These conditions include:

• HIV
• end stage renal disease
• a history of heart failure
• TB
• lupus and some other autoimmune conditions
• malignant tumors
• injuries to the chest

As cardiac tamponade can result in shock or death, it always requires emergency medical treatment. This treatment involves draining excess fluid from around the heart.

A doctor may use the following methods to remove the fluid and reduce the pressure on the heart:

• Pericardiocentesis: This procedure involves the removal of fluid from the pericardium using a needle.
• Pericardiectomy: A surgeon will remove part of the pericardium to relieve pressure on the heart.
• Thoracotomy: This surgical procedure allows the draining of blood or blood clots from around the heart.

According to some research, doctors should choose minimally invasive procedures, such as pericardiocentesis, as the first treatment option. Such options carry a less significant risk of complications and have lower mortality rates.

However, more complicated cases of cardiac tamponade will often require surgery, such as a thoracotomy.

After surgery, the individual may receive the following as they stabilize:

• IV fluids to maintain normal blood pressure
• medications to increase blood pressure
• blood products to replace the lost blood
• oxygen to reduce stress on the heart

Once the person is stable, the doctor will need to determine and treat the underlying cause of the cardiac tamponade to prevent further complications.

The treatment options at this stage will depend on the cause of the cardiac tamponade.

A person may need to take anti-inflammatory medication, such as colchicine. A 2020 study concluded that people taking colchicine after successful pericardiocentesis showed significant improvement.

Untreated cardiac tamponade can lead to shock, arrhythmia, chest pain, organ dysfunction, and, in some cases, death. According to the National Cancer Institute, it may also lead to organ failure.

However, complications may occur during treatment.

Pericardiocentesis

According to a 2017 study, the complications of pericardiocentesis include:

• rapid drop in heart rate and blood pressure
• supraventricular arrhythmia, which is the term for an irregular heart rate
• pneumothorax, which is a collapsed lung
• pleuropericardial fistula, in which the lung connects abnormally to the pericardium

Other major complications of this procedure include:

• damaging nearby blood vessels, including puncturing cardiac vessels or internal mammary vessels
• cutting the liver
• puncturing the right ventricle of the heart

Pericardiectomy

The possible complications of pericardiectomy include:

• excessive bleeding
• atrial and ventricular arrhythmias
• ventricular wall rupture
• injury to the phrenic nerve injury, which controls the movement of the diaphragm

Thoracotomy

According to the American Lung Association, the complications of thoracotomy include:

• infection
• bleeding
• persistent air leakage from the lung
• post-thoracotomy pain syndrome, which involves persistent chest pain and nerve damage

The outlook for people with cardiac tamponade depends on:

• how quickly they receive treatment for the condition
• possible complications
• the underlying cause

People with a noncancerous cause of cardiac tamponade have a mortality rate that is less than 15%. However, this rate rises to 80% within 1 year when cancer is the cause.

Mortality rates are also higher among those who have sepsis, acute kidney injury, or a chest injury.

Prompt diagnosis and early treatment significantly improve the outlook for people with cardiac tamponade. Without treatment, the condition is fatal.

It is not possible to prevent all cases of cardiac tamponade. However, people can reduce their risk by:

• minimizing their exposure to bacterial or viral infections
• receiving treatment for medical conditions, such as lupus and hypothyroidism
• eating a well-balanced diet and exercising regularly to protect heart health
• attending regular medical checkups
• avoiding smoking

Cardiac tamponade is an uncommon but severe medical condition that can result in shock or death. It is vital that anyone who suspects that they have cardiac tamponade seek emergency treatment.

The treatment for cardiac tamponade involves draining the excess fluid from the pericardium, stabilizing blood pressure, and treating the underlying cause.

People who receive a prompt diagnosis and appropriate treatment generally have a better outlook.

Although it is not possible to prevent all cases of cardiac tamponade, people should be aware of their risk factors and discuss preventive methods with a doctor.