Why does cardiac tamponade

Medically reviewed by Gerhard Whitworth, R. Causes Signs and symptoms Diagnosis Prevalence Treatments Outlook Prevention Summary Cardiac tamponade is the accumulation of fluid around the heart muscle, which places excessive pressure on this organ. Share on Pinterest A buildup of fluid around the heart muscles causes cardiac tamponade.

Image credit: Blausen. Signs and symptoms. Is cardiac tamponade common? Share on Pinterest An early diagnosis can improve the outlook for people with cardiac tamponade. Latest news Adolescent depression: Could school screening help? Exposure to air pollutants may amplify risk for depression in healthy individuals. Related Coverage. Sepsis: What you need to know Medically reviewed by Kristen M. Moyer, MD. What causes a bounding pulse? Medically reviewed by Gerhard Whitworth, RN.

What is fainting, and what causes it? Medically reviewed by Seunggu Han, MD. A physical exam may show: Blood pressure that falls when breathing deeply Rapid breathing Heart rate over normal is 60 to 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: Chest CT or MRI of chest Chest x-ray Coronary angiography ECG Right heart catheterization.

Cardiac tamponade is an emergency condition that needs to be treated in the hospital. The cause of tamponade must be found and treated. Outlook Prognosis. Possible Complications. When to Contact a Medical Professional. Alternative Names. Tamponade; Pericardial tamponade; Pericarditis - tamponade. Heart - front view Pericardium Cardiac tamponade. Pericardial Disorders Read more. It is typically used in post-cardiac surgery patients suspected of having loculated effusions containing clots.

Additional imaging with magnetic resonance or computed tomography is normally not necessary to diagnose cardiac tamponade, but can be used as second-line imaging in cases of complex or loculated effusions and evaluation of associated or extracardiac diseases or findings. Depending on the underlying cause of the pericardial fluid, lab test and analysis of the pericardial fluid can supply diagnostics.

However, most effusions are transudate and do not yield the underlying cause, but it is good practice to analyse the pericardial fluid for white blood cell count, haematocrit, malignant cells and protein content [14,15]. When tamponade is present or threatened, clinical decision making requires urgency, and the threshold for pericardiocentesis should be low. The treatment of cardiac tamponade is drainage, preferably by needle paracentesis with the use of echocardiographic or another type of imaging, such as fluoroscopy [14,16].

The needle tip is evident on imaging, and imaging can thus be used to identify the optimal point to perform the centesis [17]. Imaging guidance allows the operator to select the shortest and safest route to the effusion. Open surgical drainage is normally not necessary, but based upon local preference and experience, and is desirable if intrapericardial bleeding is present, when there is a clotted pericardium and if needle centesis is difficult or ineffective.

Treatment should be individualised, and thoughtful clinical judgement is essential. Patients with large effusions with minimal or no evidence of haemodynamic compromise may be treated conservatively with careful follow-up and monitoring, and therapy aimed towards the underlying cause. Thus, patients with apparently idiopathic pericarditis and mild tamponade could be treated for a period with non-steroidal anti-inflammatory drugs NSAID and colchicine in the hope that the effusion will shrink.

The same approach or strategy could be performed in patients with connective tissue or inflammatory diseases. Unfortunately, there are no proven effective medical therapies to reduce an isolated effusion. In the absence of inflammation, NSAID, colchicine and corticosteroids are generally not effective [14]. Pericardiocentesis alone may be necessary for the resolution of large effusions, but recurrences are also common, and surgical pericardiectomy or less invasive options i.

Loculated effusions due to bleeding are difficult to drain sufficiently with a closed approach, whereas surgical drainage affords the opportunity to correct the source of the bleeding. Once tamponade is diagnosed, management should be orientated toward urgent pericardiocentesis. Preparing the pericardiocentesis, intravenous hydration and positive inotropes can be used temporarily, but should not be allowed to substitute for or delay pericardiocentesis. The risk and benefits of needle centesis should be considered in patients with anticoagulation therapy or if coagulopathy is present.

Mechanical ventilation should be avoided due to a further decrease in cardiac output [16]. In case of cardiac arrest due to tamponade, external cardiac compression has limited or no value because there is little room for additional filling [18].

A triage system has been proposed by the ESC Working Group on Myocardial and Pericardial Diseases in order to guide the timing of the intervention and the possibility of transferring the patient to a referral centre [1]. This triage system is essentially based on expert consensus and requires additional validation in order to be recommended in clinical practice. Jesper K. Our mission: To reduce the burden of cardiovascular disease.

Help centre. All rights reserved. Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more. Show navigation Hide navigation. Sub menu. Cardiac tamponade: a clinical challenge Vol. Prof Steen Hvitfeldt Poulsen. Topic s : Pericardial Disease. Causes The pericardium is a double-walled sac containing the heart and the roots of the great vessels and is composed of a visceral and parietal component.

A procedure that uses a needle to remove fluid from the tissue that surrounds the heart will be done. A surgical procedure to cut and remove part of the covering of the heart 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. Death due to cardiac tamponade can occur quickly if the fluid or blood is not removed promptly from the pericardium. The outcome is often good if the condition is treated promptly. However, tamponade may come back. Go to the emergency room or call the local emergency number such as if symptoms develop. Cardiac tamponade is an emergency condition that needs immediate medical attention.

Many cases can't be prevented. Knowing your personal risk factors may help you get early diagnosis and treatment.