Cardiac tamponade is pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle (myocardium) and the outer covering sac of the heart (pericardium).
Tamponade; Pericardial tamponade
In this condition, blood or fluid collects in the pericardium, 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:
- Dissecting aortic aneurysm (thoracic)
- End-stage lung cancer
- Heart attack (acute MI)
- Heart surgery
- Pericarditis caused by bacterial or viral infections
- Wounds to the heart
Other possible causes include:
- Heart tumors
- Kidney failure
- Placement of central lines
- Radiation therapy to the chest
- Recent invasive heart procedures
- Recent open heart surgery
- Systemic lupus erythematosus
Cardiac tamponade occurs in about 2 out of 10,000 people due to disease.
- 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, light-headedness
- Pale, gray, or blue skin
- Rapid breathing
- Swelling of the abdomen or other areas
Other symptoms that may occur with this disorder:
- Weak or absent pulse
Exams and Tests
There are no specific laboratory tests that diagnose tamponade. Echocardiogram is very often used 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 (pulsus paradoxical) 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:
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. Pericardiocentesis is a procedure that uses a needle to remove fluid from the tissue that surrounds the heart (pericardial sac).
A surgical procedure to cut and remove part of the 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.
Cardiac tamponade is a medical emergency. If the fluid or blood is not quickly removed from the pericardium, death can occur quickly.
The outcome is often good if the condition is treated promptly. However, tamponade may come back.
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.
Many cases are not preventable. Knowing your personal risk factors may help you get early diagnosis and treatment.
LeWinter MM, Tischler MD. Pericardial diseases. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadlephia, PA: Saunders Elsevier; 2011:chap 75.
Little WC, Oh JK. Pericardial diseases. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 77.
Mallemat HA,l Tewelde SZ. Pericardiocentesis. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Saunders Elsevier; 2013:chap 16.