Cardiac Tamponade

What is cardiac tamponade?

Cardiac tamponade is a life-threatening condition caused by fluid under pressure 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 beats.

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.

What causes cardiac tamponade?

Sudden bleeding into the pericardium is one cause of cardiac tamponade. This may be the result of injury or accident. Rupture of the heart muscle from a heart attack or a tear in the aorta (the large blood vessel leading from the heart) are other causes. Pericarditis, an inflammation of the pericardium, may cause fluid and cardiac tamponade. Cancers in or near the heart can leak fluid into the pericardium and cause cardiac tamponade.

What are the symptoms of cardiac tamponade?

Symptoms may be very mild. Most people with cardiac tamponade have some shortness of breath. Most have falling blood pressure and a fast heart rate. Veins in the neck or the arms may be swollen. Fainting spells may occur. Complaints of weakness and of feeling bad are common.

How is cardiac tamponade diagnosed?

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

You may also have an echocardiogram. This test uses ultrasound waves to show 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 tamponade is present.

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

How is cardiac tamponade treated?

Severe cardiac tamponade requires prompt treatment because it can be fatal. Some or all of the pericardial fluid must be removed immediately. With the area numbed by a shot, 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 surgery is recommended instead of drainage through a needle to remove the fluid and some tissue.

Symptoms usually improve quickly after the fluid is removed. Some of the fluid is sent to the laboratory to be checked for blood cells, cancer cells, or infection. The drainage tube is usually left in place for a day or two and then removed. Sometimes a special needle is used to get small samples (biopsies) of the pericardium for examination by microscope.