Cardiac Tamponade

What is cardiac tamponade?

Cardiac tamponade is a life-threatening condition caused by too much fluid around the heart. The heart lies inside a tissue sac called the pericardium. Fluid that collects in the pericardial sac can exert enough pressure to prevent the heart from relaxing completely between heartbeats. The pressure prevents the heart from filling completely with blood just before the next heartbeat. This lessens the amount of blood that can be pumped by the heart. Severe pericardial fluid pressure can cause a drop in blood pressure, shock, abnormal heart rhythms, and death.

How does it occur?

A number of problems can cause cardiac tamponade.

• sudden bleeding into the pericardium from an injury
• a tear (rupture) of the heart muscle from a heart attack
• a tear in the aorta (the large blood vessel leading from the heart)
• pericarditis, which is an inflammation of the pericardium
• cancer in or near the heart.

What are the symptoms?

The symptoms may be very mild. Symptoms may include:

• shortness of breath
• low blood pressure
• fast heart rate
• swollen veins in the neck or the arms
• fainting spells
• weakness and feeling bad.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. Your provider will measure your blood pressure. A large change in blood pressure between the end of one breath and the start of the next breath is a sign of cardiac tamponade.

You may have an echocardiogram. This test uses ultrasound waves to look for fluid in the sac around the heart. As the fluid pressure increases, abnormalities appear in the way the heart fills and ejects blood. These abnormalities help to determine if you have cardiac tamponade.

Sometimes it is necessary to measure the pressure inside the heart chambers with a test called cardiac catheterization.

How is it treated?

Severe cardiac tamponade requires prompt treatment because it can be fatal. Some or all of the pericardial fluid must be removed right away. The fluid may be removed with a needle or surgery. When a needle is used for drainage, an area of your chest is numbed with a shot of anesthetic. Then a needle is put through the chest wall over the heart or through the area just under the breastbone. The needle punctures the pericardial sac around the heart. Once the puncture is made, a tube is put in to drain the fluid.

Sometimes a special needle is used to get small samples (biopsies) of the pericardium for examination by microscope.

Sometimes surgery is done to remove the fluid and some tissue. The surgeon opens the pericardial sack to drain some of the fluid. The drain may be left in place for several days to help prevent another buildup of fluid. Sometimes a small area of pericardium is removed so that fluid cannot build up again.

Some of the fluid removed from the pericardium is sent to the lab to be checked for blood cells, cancer cells, or infection.

How long do the effects last?

Symptoms usually get better quickly after the fluid is removed. The drainage tube is usually left in place for a day or two and then removed.

How can I take care of myself?

Keep all follow-up visits with your healthcare provider.