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 functioning normally. As a result, the body does not receive 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
• Hypothyroidism
• Kidney failure
• Leukemia
• 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.

• Anxiety, restlessness
• Chest pain
  • Radiating to the neck, shoulder, back, or abdomen
  • Sharp, stabbing
  • Worsened by deep breathing or coughing
• Difficulty breathing
• Discomfort, sometimes relieved by sitting upright or leaning forward
• Fainting, light-headedness
• Pale, gray, or blue skin
• Palpitations
• Rapid breathing
• Swelling of the abdomen or other areas

Other symptoms that may occur with this disorder:

• Dizziness
• Drowsiness
• Weak or absent pulse

There are no specific laboratory tests that diagnose tamponade. Echocardiogram is typically used to help establish the diagnosis. In emergency cases, echocardiogram is done at the bedside.

Signs:

• Blood pressure may fall (pulsus paradoxical) when the person breathes in deeply
• Breathing may be rapid
• Heart rate may be over 100 (normal is 60 to 100 beats per minute)
• Heart sounds are faint during examination with a stethoscope
• Neck veins may be abnormally extended (distended) but the blood pressure may be low
• Patient may look ill and frightened
• Peripheral pulses may be weak or absent

Other tests may include:

• Chest CT or MRI of chest
• Chest x-ray
• Coronary angiography
• ECG

Cardiac tamponade is an emergency condition that requires hospitalization.

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 pericardial sac, the tissue that surrounds the heart.

A procedure to cut and remove part of the pericardium (surgical pericardiectomy or pericardial window) may also be done.

Fluids are given to maintain normal blood pressure until pericardiocentesis can be performed. Medications that increase blood pressure may also help sustain the patient's life until the fluid is drained.

The patient may be given oxygen. This reduces the workload on the heart by decreasing tissue demands for blood flow.

The cause of tamponade must be identified 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, but tamponade may come back.

• Heart failure
• Pulmonary edema
• Shock
• Death

Go to the emergency room or call the local emergency number (such as 911) if symptoms develop. Cardiac tamponade is an emergency condition requiring immediate attention.

Many cases are not preventable. Awareness of your personal risk factors may allow 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. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 77.

Harper RJ. Pericardiocentesis. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 16.