Cardiac Tamponade: What to Know

Cardiac tamponade is a serious medical condition in which the heart cannot effectively pump blood through the body due to fluid buildup around the heart. The decreased blood flow through the body can lead to organ failure, shock, and even death.

Immediate medical care is necessary for those who are experiencing the symptoms of cardiac tamponade. This article will discuss everything readers need to know about the condition.

What Happens During Cardiac Tamponade?

Cardiac tamponade is a medical emergency when too much fluid builds up in the pericardial space. The pericardial space is the area between the heart muscle and the thin sac surrounding the heart called the pericardium.

A small amount of fluid normally exists between the pericardial sac and heart muscle to provide lubrication. However, when too much fluid builds up, it can be dangerous.

Cardiac tamponade occurs when the amount of fluid becomes too large and puts pressure on the heart. This prevents the heart's ventricles from filling completely, which decreases the amount of blood the heart can pump to the body.

Decreased blood flow to the body (decreased cardiac output) can cause shock. Shock is when organs and tissues do not receive enough blood and begin to shut down.

What Causes Fluid Around the Heart?

In cardiac tamponade, there is an excess amount of fluid surrounding the heart, preventing it from pumping effectively. Sometimes, the excess fluid is a clear, serous fluid. This dangerous fluid buildup is called a pericardial effusion.

Other times, blood collecting around the heart causes pressure. Several conditions or situations can cause this to happen. They include:

• Pericarditis: Inflammation of the pericardial sac
• Surgery: Fluid or blood that builds up around the heart after chest or heart surgery
• Cancer: Lung cancer that spreads to the pericardium
• Dissecting aortic aneurysm: A tear that develops in the large artery carrying blood out of the heart
• Heart attack: Decreased or no blood flow to the coronary arteries

Other less common causes of cardiac tamponade are:

• Leukemia (blood cancer)
• Kidney failure
• Heart tumor
• Chest radiation therapy
• Lupus (a chronic inflammatory autoimmune disease)
• Dermatomyositis (a rare inflammatory autoimmune disease of the skin and muscles)
• Heart failure

What Are the Symptoms of Cardiac Tamponade?

Symptoms of cardiac tamponade include:

• Anxiety
• Restlessness
• Difficulty or fast breathing
• Light-headedness
• Discomfort that goes away when sitting upright or leaning forward
• Sharp chest pain felt in the neck, shoulder, or back
• Palpitations

Signs of Cardiac Tamponade: Beck's Triad

In addition to these symptoms, a healthcare provider might detect several signs of cardiac tamponade, such as Beck's triad. This is a group of three clinical findings that are often found in people with cardiac tamponade. Beck's triad findings are:

• Hypotension (low blood pressure)
• Jugular vein distension
• Muffled or distant heart sounds

Another clinical finding that is seen with cardiac tamponade is pulsus paradoxus. This is when the systolic blood pressure (top number) decreases more than 10 millimeters of mercury (mm Hg) when breathing in.

How Is Cardiac Tamponade Diagnosed?

Cardiac tamponade may present with symptoms similar to many other conditions, making a diagnosis based on symptoms alone difficult. A healthcare provider will perform an evaluation which may find weak pulses, fast heart rate, quick breathing, and bulging neck veins.

The primary tool used to make a diagnosis is an echocardiogram (echo). This is an ultrasound of the heart done with a device placed on the chest that produces images on an echo machine.

Other diagnostic tools that can be used to help make a diagnosis include:

• Chest X-ray
• Computed tomography (CT)
• Magnetic resonance imaging (MRI)
• Electrocardiogram (ECG or EKG)
  

How Is Cardiac Tamponade Treated?

The mainstay treatment for cardiac tamponade is pericardiocentesis. This procedure drains the fluid from around the heart.

It is done by a healthcare provider who uses live X-rays or ultrasounds to guide a needle inserted into the chest. The needle is then moved into the tissue around the heart. A plastic catheter is guided over the needle, and the needle is removed. Fluid drains out of the catheter. The catheter can remain in as a drain or can be removed right away.

Another treatment option is a pericardial window. This is a surgical procedure in which the surgeon removes a small part of the pericardium to allow the fluid to drain.

A surgeon may choose to perform a pericardial window if cardiac tamponade recurs, there is active bleeding within the chest or heart, or if a biopsy (a tissue sample taken and analyzed in the lab) is necessary.

What’s the Long-Term Outlook?

The outlook for someone with cardiac tamponade will depend upon the underlying condition that caused it and how quickly the person seeks treatment.

When someone has a prompt diagnosis and treatment for cardiac tamponade, the outcome is good. However, if the fluid is not removed quickly, cardiac tamponade can lead to shock and death.

It's important to keep follow-up appointments as pericardial effusions can recur.

Who’s at Risk for Cardiac Tamponade?

Those who are at risk for cardiac tamponade are people who are more likely to have pericardial effusion. This includes those who have chest or heart surgery, cancer, or kidney disease or who receive radiation therapy.

Anyone who has the underlying risk factors for cardiac tamponade should work closely with their healthcare provider to monitor symptoms and identify any changes that could indicate fluid buildup in the pericardial space.

Seek Immediate Medical Care

If you are at risk for cardiac tamponade and feel any of its symptoms. seek immediate medical care. Cardiac tamponade is a medical emergency. The only successful treatment is a hospital procedure to remove the fluid around the heart.

If cardiac tamponade is left untreated, the continued pressure on the heart will cause less blood flow to the body and lead to organ failure and death. If a healthcare provider detects signs of it, such as Beck's triad, they will ensure you get emergency medical care.

Summary

Cardiac tamponade is a serious medical condition caused by the accumulation of fluid around the heart. The fluid presses against the heart, preventing it from filling with blood. This, in turn, reduces the amount of blood that is sent to the body, causing the organs and tissues to receive less oxygen and nutrients.

A prompt diagnosis and treatment can lead to positive outcomes. However, if left untreated, it can cause shock and death.