Compression of the heart caused by blood or fluid accumulation in the space between the myocardium (the muscle of the heart) and the pericardium (the outer covering sac of the heart).

Alternative Names

Tamponade; Pericardial tamponade

Causes, incidence, and risk factors

In this condition, blood or fluid collects within the pericardium. This prevents the ventricles from expanding fully, so they cannot adequately fill or pump blood. Cardiac tamponade is often associated with pericarditis caused by bacterial or viral infections. Heart surgery, dissecting aortic aneurysm (thoracic), stabbing wound to heart, end stage lung cancer, and acute MI can all lead to cardiac tamponade. Other potential causes include heart tumors, kidney failure , recent heart attack , recent open heart surgery, recent invasive heart procedures, radiation therapy to the chest, hypothyroidism and systemic lupus erythematosus . Cardiac tamponade occurs in approximately 2 out of 10,000 people.

Signs and tests

Although there are no specific laboratory tests that diagnose tamponade, echocardiogram is first choice to help establish the diagnosis. The heart will often sound uncharacteristically faint during examination with a stethoscope.

Peripheral pulses may be weak or absent. Neck veins may be distended but the blood pressure may be low. The heart rate may be over 100 (normal is 60 to 100 beats per minute), and breathing may be rapid (faster than 12 breaths in an adult per minute). The blood pressure may fall (pulsus paradoxical) when the person inhales deeply.

Fluid in the pericardial sac may show on:

Chest X-ray

Echocardiogram

Chest CT

or

MRI of chest

Coronary angiography

(may show other changes also)

ECG

changes include low voltage wave forms

Treatment

Cardiac tamponade is an emergency condition that requires hospitalization. Treatment is aimed at saving the patient's life, improving heart function, relieving symptoms, and treating the tamponade. These goals are usually accomplished with a procedure called pericardiocentesis , where the fluid around the heart is drained, or by cutting and removing part of the pericardieum (pericardial window). Fluids are the initial treatment to maintin 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 evacuated. The patient may be given oxygen -- this reduces the workload on the heart by decreasing tissue demands for blood flow. The cause of the tamponade must be identified and treated. Treatment of the cause may include medications, such as antibiotics, and surgical repair of injury. Cutting and/or removal of part of the pericardium (surgical pericardiectomy also known as pericardial window) may be required for most tamponade patients.

Expectations (prognosis)

Tamponade is life threatening if untreated. The outcome is often good if the condition is treated promptly, but tamponade may recur.

Complications

Heart failure

Pulmonary edema

Calling your health care provider

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!

Prevention

Many cases are not preventable. Awareness of your personal risk factors may allow early diagnosis and treatment.