Cardiac Tamponade

Cardiac tamponade is a rare, but potentially fatal, condition. It is caused by the buildup of blood or fluid in the pericardial sac surrounding the heart. This extra fluid results in excess pressure on the heart, impairing its ability to pump blood as it should. The accumulation of fluid may occur gradually (subacute) or rapidly (acute). As it continues to build up, the fluid affects the heart’s ability to beat properly and will ultimately lead to cardiac arrest. The only way to recover from cardiac tamponade is to surgically relieve the tamponade.

Causes of Cardiac Tamponade

Cardiac tamponade is normally caused by the pericardium being somehow punctured. This results in the cavity filling with blood or other bodily fluids. Causes may include:

• gunshot or stab wounds
• chest trauma resulting from a car accident
• accidental perforation after cardiac catheterization, angiography, or insertion of a pacemaker
• cancer that has spread to the pericardial sac
• a ruptured aortic aneurysm
• pericarditis (inflammation of the pericardium)
• lupus, an inflammatory disease in which the immune system mistakenly attacks healthy tissues
• high levels of radiation to the chest
• hypothyroidism, which increases the risk for heart disease
• heart attack
• kidney failure
• infections that affect the heart

Signs and Symptoms

Symptoms of cardiac tamponade vary depending upon the acuteness and cause of the tamponade, but may include the following:

• chest pain or pressure
• rapid breathing or breathing problems
• fainting or lightheadedness
• confusion
• decreased urine output
• palpitations

Cardiac Tamponade Treatment

Cardiac tamponade treatment is a medical procedure that requires hospitalization. A needle is used to remove the fluid from the pericardial sac (pericardiocentesis). Paramedics rarely have the necessary equipment to perform a pericardiocentesis, so pre-hospital treatment involves managing hypotension and shock symptoms and immediately transporting the patient to the hospital.

Once in the hospital, the first line of treatment is normally pericardiocentesis. A cannula is placed to help evacuate more fluid should it continue to accumulate, usually with the assistance of an ultrasound. It may also be necessary to cut and remove part of the pericardium, also known as surgical pericardiectomy. In order to keep the patient’s blood pressure stable, fluids, oxygen, and medications may be given until the fluid can be drained.