Cardiac Tamponade Symptoms, Causes & Treatment Options

Cardiac tamponade is an acute condition where fluid builds up between your heart and the surrounding membrane or sac and decreases the ability for your heart to pump blood properly.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is Cardiac Tamponade?

Summary

The heart normally has a protective layer or sac which is called the pericardium. This sac serves various important purposes including acting as a barrier against infections, maintaining the size of the heart chambers, and allowing the heart to pump blood at different speeds. Between the heart and this layer (pericardial space) is a small amount of lubricating fluid. [1,2]

An abnormal amount of fluid in this space can push against the heart chambers and decrease the filling of the heart. When this (pericardial) fluid builds up too quickly or accumulates to a large volume over time, this becomes cardiac tamponade which is a life-threatening emergency. Underlying causes of tamponade include infection, underlying cancer, trauma, cardiac surgery, and inflammatory diseases such as lupus and rheumatoid arthritis. [1,2,3]

Symptoms may vary but often include chest pain, shortness of breath, fatigue, lightheadedness, and pale or cool extremities. Other symptoms also include distended neck veins, low blood pressure, and a fast heart rate.

Diagnosis is done by an ultrasound (echocardiogram) and requires immediate attention in the emergency department or within the hospital. Treatments include draining the fluid from the pericardial space and monitoring while obtaining further lab testing and imaging studies to determine potential sources.

Recommended care

Cardiac Tamponade Symptoms

Main symptoms

These are the symptoms that are most commonly associated with cardiac tamponade:

  • Difficulty breathing: People with cardiac tamponade may experience shortness of breath, especially with walking or any exertion. Since the pericardial fluid restricts proper filling of the heart, there are fewer nutrients and less oxygen that can be pumped forward to the vital organs including your lungs. [3]
  • Chest pain: The increased pressure in the pericardial space during tamponade can also lead to chest discomfort. Your heart requires nutrients and oxygen just like the lungs, and during tamponade, your heart is straining against the fluid accumulation and requires more energy to work properly. [3]
  • Fatigue: In tamponade, your heart is unable to pump properly, and therefore, you may have a decreased blood pressure and decreased blood flow and oxygen delivered to your brain. This can lead to profound tiredness even with little activity. [3]
  • Lightheadedness: Low blood pressure and fast heart rates can be seen in cardiac tamponade. This can make you feel dizzy and lightheaded along with the tiredness noted above. [3]
  • Distended neck veins: When your heart is unable to fill properly and feels pressure from the pericardial fluid, this can cause blood to back up into the veins that lead to the heart. This can result in noticeable enlargement of your neck veins. [1,2,3]

Diagnosis

If you are experiencing symptoms above you should go see a provider immediately, so that you can receive the proper testing. The diagnosis of cardiac tamponade is initially suspected when a patient has low blood pressure, or a decreased gap between the two blood pressure numbers, or a fast heart rate, along with the symptoms noted above. [3,4,5] Any significant recent trauma or cardiac surgery can also raise the concern for tamponade. [5]

While vital signs and physical exam are the initial part of the evaluation, the standard diagnostic tool is the echocardiogram or ultrasound image of the heart. [2] Chest x-rays, chest CT scans, and EKGs (electrocardiograms) can all reflect signs of fluid accumulation around the heart, but the ultrasound provides the most useful information in diagnosing cardiac tamponade. [2]

There may be abnormal laboratory tests that reflect early signs of liver or kidney damage or signs of shock due to cardiac tamponade since the heart cannot pump efficiently to the vital organs. However, lab tests are generally not the main method of diagnosis.

Cardiac Tamponade Causes

There are many different causes of cardiac tamponade since there is a wide range of conditions that can lead to a build-up of fluid around the heart. These can be generally classified into general sources including infections, trauma, inflammatory, cancers, medication-induced, procedure or surgery-related, and idiopathic or unclear origin. [1] The most common cause of cardiac tamponade is “pericarditis,” which is an inflammation of the pericardial sac due to both infectious and non-infectious causes. [3]

Infections

Many different types of infections can lead to fluid build-up and increase the risk for cardiac tamponade if a person develops pericarditis. Viral, bacterial, and fungal infections include:

  • HIV (human immunodeficiency virus)
  • Influenza
  • Herpes virus
  • Tuberculosis
  • Histoplasmosis
  • Staphylococcus
  • Coxsackievirus

Bleeding

Cardiac tamponade can result from non-bloody fluid or blood build-up. Blood can build up around the heart after severe trauma to the chest, such as a direct stab wound, serious motor vehicle accident, or after a procedure involving the heart.

  • Penetrating or blunt chest injury
  • Catheterization of the heart
  • Open heart surgery
  • Aortic dissection (or damage to your large blood vessels from the heart)
  • Pacemaker placement
  • Heart attack

Cancer

Having an underlying cancer diagnosis and undergoing treatment may be a potential cause of cardiac tamponade.

  • Radiation therapy
  • Breast cancer
  • Lung cancer (most common) [1]
  • Kidney cancer
  • Lymphoma
  • Leukemia

Inflammatory

Cardiac tamponade may also be caused by underlying rheumatological or immune system-related diseases that lead to pericarditis. This is less commonly seen. [3]

  • Lupus
  • Rheumatoid arthritis
  • Kidney disease or failure
  • Scleroderma

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Treatment Options, Relief, and Prevention for Cardiac Tamponade

Treatment

Cardiac tamponade, once diagnosed, is an emergency and requires immediate intervention. The first step is providing intravenous fluids which will help with filling of the heart chambers [2]. Further supportive care can be provided with intravenous medications called “pressors,” which help maintain proper blood pressure and may assist your heart with pumping blood to the body [2,5].

However, the definite treatment is drainage of the pericardial fluid, which is generally performed under ultrasound guidance or continuous X-ray imaging. In certain cases, the fluid may need to be drained through a surgical approach especially in traumatic cases or where continuous bleeding needs to be controlled [2,5].

Once the fluid is evacuated, treatment also involves addressing the underlying source of the cardiac tamponade. This is guided through further diagnostic tests to identify one of the causes listed above and then provide the appropriate medications or therapy.

  • Inflammatory causes may be treated with medications such as NSAIDs (non-steroidal anti-inflammatory drugs)
  • Antibiotic, antifungal, or antiviral medications may be provided for any underlying infections
  • Any underlying vessel or heart chamber injuries should be repaired surgically

Prevention

Preventing cardiac tamponade is mainly focused around early identification of increased fluid in the pericardial region around the heart. If the fluid collection is stable, it may potentially be managed through medications and resolve over time without developing into cardiac tamponade. [3]

People who have had prior history of cardiac tamponade, or fluid around the heart, should be monitored through regular check-ups with their cardiologist or other specialties including rheumatology, oncology/hematology, or pulmonology.

When to Seek Further Consultation for Cardiac Tamponade

If you experience any of the symptoms above, especially if you had a recent heart procedure or surgery, you should go to the emergency room for further evaluation. If you have known increased fluid around your heart based on recent ultrasound or CT scan studies, you should also be seen urgently by a doctor for further management.

There are other conditions that may cause similar symptoms, and so your providers may consider various lab tests and imaging tests to determine the diagnosis.

Cardiac tamponade is a life-threatening condition that requires immediate treatment and identification of the source.

References

  1. Ariyarajah V, Spodick DH. Cardiac Tamponade Revisited. Texas Heart Institute Journal. 2007; 34(3): 347-351

  2. Collins D. Aetiology and Management of Acute Cardiac Tamponade. Critical Care and Resuscitation. 2004; 6: 54-58

  3. Jensen JK, Poulsen SH, Molgaard H. Cardiac Tamponade: a clinical challenge. Journal of Cardiology Practice. 2017; 15: 17-27

  4. Schiavone WA. Cardiac Tamponade: 12 pearls in diagnosis and management. Cleveland Clinic Journal of Medicine. 2013; 80(2): 109-116

  5. Spodick DH. Acute Cardiac Tamponade. The New England Journal of Medicine. 2003; 349:684-690