Cardiac Tamponade

Definition

Cardiac tamponade occurs when the heart is squeezed by fluid that collects inside the sac that surrounds it.

Description

The heart is surrounded by a sac called the pericardium. When this sac becomes filled with fluid, the liquid presses on the heart, preventing the lower chambers of the heart from properly filling with blood.

Because the lower chambers (the ventricles) cannot fill with the correct amount of blood, less than normal amounts of blood reach the lungs and the rest of the body. This condition is very serious and can be fatal if not treated.

Causes and symptoms

Fluid can collect inside the pericardium and compress the heart when the kidneys do not properly remove waste from the blood, when the pericardium swells from unknown causes, from infection, or when the pericardium is damaged by cancer. Blunt or penetrating injury from trauma to the chest or heart can also result in cardiac tamponade when large amounts of blood fill the pericardium. Tamponade can also occur during heart surgery.

When the heart is compressed by the surrounding fluid, three conditions occur: a reduced amount of blood is pumped to the body by the heart, the lower chambers of the ventricles are filled with a less than normal amount of blood, and higher than normal blood pressures occur inside the heart, caused by the pressure of the fluid pushing in on the heart from the outside.

When tamponade occurs because of trauma, the sound of the heart beats can become faint, and the blood pressure in the arteries decreases, while the blood pressure in the veins increases.

In cases of tamponade caused by more slowly developing diseases, shortness of breath, a feeling of tightness in the chest, increased blood pressure in the large veins in the neck (the jugular veins), weight gain, and fluid retention by the body can occur.

Diagnosis

When cardiac tamponade is suspected, accurate diagnosis can be life-saving. The most accurate way to identify this condition is by using a test called an echocardiogram. This test uses sound waves to create an image of the heart and its surrounding sac, making it easy to visualize any fluid that has collected inside the sac.

Treatment

If the abnormal fluid buildup in the pericardial sac is caused by cancer or kidney disease, drugs used to treat these conditions can help lessen the amount of fluid collecting inside the sac. Drugs that help maintain normal blood pressure throughout the body can also help this condition; however, these drugs are only a temporary treatment. The fluid within the pericardium must be drained out to reduce the pressure on the heart and restore proper heart pumping.

The fluid inside the pericardium is drained by inserting a needle through the chest and into the sac itself. This allows the fluid to flow out of the sac, relieving the abnormal pressure on the heart. This procedure is called pericardiocentesis. In severe cases, a tube (catheter) can be inserted into the sac or a section of the sac can be surgically cut away to allow for more drainage.

Prognosis

This condition is life-threatening. However, drug treatments can be helpful, and surgical treatments can successfully drain the trapped fluid, though it may reaccumulate. Some risk of death exists with surgical drainage of the accumulated fluid.

BOOKS

Braunwald, Eugene. "Pericardial Disease." In Harrison's Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.

Shabetai, Ralph. "Diseases of the Pericardium." In Hurst's The Heart, ed. Robert C. Schlant, et. al. New York: McGraw Hill, 1994.

ORGANIZATIONS

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. <http://www.americanheart.org>.

Dominic De Bellis, PhD

KEY TERMS

Pericardiocentesis—A procedure used to drain fluid out of the sac surrounding the heart. This is done by inserting a needle through the chest and into the sac.