Cardiac Tamponade

What is cardiac tamponade?

Cardiac tamponade happens when extra fluid builds up in the space around the heart. This fluid puts pressure on the heart and prevents it from pumping well. This is a medical emergency.

A fibrous sac called the pericardium surrounds the heart. This sac is made up of 2 thin layers. Normally, a small amount of fluid is found between the 2 layers. The fluid prevents friction between the layers when they move as the heart beats. In some cases, extra fluid can build up abnormally between these 2 layers. If too much fluid builds up, the extra fluid can make it hard for the heart to expand normally. Because of the extra pressure, less blood enters the heart from the body. This can reduce the amount of oxygen-rich blood going out to the body.

If the fluid builds up around the heart too quickly, it can lead to short-term (acute) cardiac tamponade. It’s life-threatening if not treated right away. Another type of cardiac tamponade (subacute) can happen when the fluid builds up more slowly. This is also life-threatening.

Cardiac tamponade is rare. But anyone can develop this health problem.

What causes cardiac tamponade?

Cardiac tamponade results from fluid buildup in the sac around the heart. This fluid buildup is called a pericardial effusion. Often the pericardial sac also becomes inflamed. Some health issues that can cause this fluid buildup are:

• Infection of the pericardial sac, such as during a viral or bacterial illness

• Cancer

• Inflammation of the pericardial sac from a heart attack

• Trauma from procedures done to the heart.

• Autoimmune disease

• Reactions to certain medicines

• Radiation treatment to the chest area

• Metabolic causes, such as chronic kidney failure, with a buildup of fluid and toxins in the body.

• After open heart surgery

Sometimes healthcare providers don’t know the cause of cardiac tamponade.

What are the symptoms of cardiac tamponade?

Symptoms are often severe and sudden in acute cardiac tamponade. In subacute cardiac tamponade, you might not have any symptoms early on. But usually the symptoms get worse with time. Possible symptoms include:

• Chest pain or discomfort

• Shortness of breath

• Fast breathing

• Increased heart rate

• Enlargement of the veins of the neck

• Fainting or lightheadedness

• Swelling in the arms and legs

• Pain in the right upper abdomen

• Upset stomach

• Fever, if you have an infection

Sometimes acute cardiac tamponade can also lead to very low blood pressure. That can cause symptoms of shock. These include cool arms, legs, fingers, and toes, pale skin, and less urine than normal.

The symptoms of cardiac tamponade may look like other health problems. Always see your healthcare provider for a diagnosis.

How is cardiac tamponade diagnosed?

Your healthcare provider will ask about your past health. You will also need an exam. Your healthcare provider may note a larger-than-normal drop in blood pressure when you take a breath. A number of tests can also help with the diagnosis. Some of these tests might include:

• Echocardiogram to look at the fluid around the heart and heart motion

• Electrocardiogram to check the heart’s electrical rhythm

• Chest X-ray to see the heart anatomy

• CT or MRI scan

Your healthcare provider must try to find the cause of the cardiac tamponade, if it’s unknown. That is especially important if you have symptoms of shock. To find the cause, you may need some of these tests:

• Blood tests to spot infection

• Blood tests to diagnose autoimmune disease

• Analysis of the fluid removed from around the heart to check for cancer or infection

• Blood tests to find metabolic problems

How is cardiac tamponade treated?

Cardiac tamponade is often a medical emergency and quick removal of the pericardial fluid is needed. The most common procedure to do so is called a pericardiocentesis. A needle and a long thin tube (a catheter) are used to remove the fluid.

In certain cases, healthcare providers might drain the pericardial sac during surgery instead. In some cases, the surgeon removes some of the pericardium. That can help diagnose the cause of the tamponade. It can also prevent the fluid from building up again. This is called a pericardial window.

Symptoms often improve quite a bit after the extra fluid is removed. The final outcome may depend on the reason for the fluid buildup, the severity of the tamponade, the speed of treatment, and other health problems you have.

 Other therapies are often given in addition to fluid removal include:

• Therapy aimed at the cause of the fluid buildup. This might be antibiotics for a bacterial infection.

• Careful watching with serial echocardiograms

• Medicine or fluids to increase blood pressure

• Pain medicine, such as aspirin

• Anti-inflammatory medicines, such as aspirin, ibuprofen, steroids, or colchicine

• Medicines to help the heart beat stronger

• Blood transfusion. You may need this if the fluid buildup is caused by trauma or is after open heart surgery.

What are possible complications of cardiac tamponade?

If treated quickly, cardiac tamponade often causes no complications. Untreated, it can lead to shock. Serious problems can result from shock. For example, reduced blood flow to the kidneys during shock can cause the kidneys to fail. Untreated shock may also lead to other organ failure and death.

What can I do to prevent cardiac tamponade?

You can cut your risk for some of the health problems that can lead to cardiac tamponade. For example, take care of your heart by:

• Eating a heart-healthy diet

• Getting enough exercise

• Maintaining a healthy weight

• Staying away from too much alcohol

• Seeing a healthcare provider regularly to treat any health problems

Many cases of cardiac tamponade can’t be prevented, though.

When should I call my healthcare provider?

Call your healthcare provider right away if you have any symptoms of cardiac tamponade. Call 911 if you are having breathing problems, chest pain, or symptoms of shock. Don’t drive yourself to the hospital or emergency department.

Key points about cardiac tamponade

• In cardiac tamponade, extra fluid builds up in the sac around the heart. The fluid pushes on the heart so it’s not able to pump normally.

• Most cases of cardiac tamponade are emergencies. Untreated, cardiac tamponade can cause shock and, ultimately, death.

• Most people with cardiac tamponade need fluid removed from around their heart.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions, especially after office hours or on weekends.