Cardiac tamponade is a serious medical condition in which blood or fluids fill the space between the sac that encases the heart and the heart muscle. This places extreme pressure on your heart. The pressure prevents the heart's ventricles from expanding fully and keeps your heart from functioning properly. Your heart can’t pump enough blood to the rest of your body when this happens. This can lead to organ failure, shock, and even death.
Cardiac tamponade is a medical emergency. If you or someone you know begins experiencing symptoms, seek medical help immediately.
Cardiac tamponade is usually the result of penetration of the pericardium, which is the thin, double-walled sac that surrounds your heart. The cavity around your heart can fill with enough blood or other bodily fluids to compress your heart. As the fluid presses on your heart, less and less blood can enter. Less oxygen-rich blood is pumped to the rest of your body as a result. The lack of blood getting to the heart and the rest of your body can eventually cause shock, organ failure, and cardiac arrest.
The causes of pericardial penetration or fluid accumulation might include:
- gunshot or stab wounds
- blunt trauma to the chest from a car or industrial accident
- accidental perforation after cardiac catheterization, angiography, or insertion of a pacemaker
- punctures made during placement of a central line, which is a type of catheter that administers fluids or medications
- cancer that has spread to the pericardial sac, such as breast or lung cancer
- a ruptured aortic aneurysm
- pericarditis, an inflammation of the pericardium
- lupus, an inflammatory disease in which the immune system mistakenly attacks healthy tissues
- high levels of radiation to the chest
- hypothyroidism, which increases the risk for heart disease
- a heart attack
- kidney failure
- infections that affect the heart
Cardiac tamponade has the following symptoms:
- anxiety and restlessness
- low blood pressure
- chest pain radiating to your neck, shoulders, or back
- trouble breathing or taking deep breaths
- rapid breathing
- discomfort that’s relieved by sitting or leaning forward
- fainting, dizziness, and loss of consciousness
Cardiac tamponade often has three signs your doctor can recognize. These signs are commonly known as Beck’s triad. They include:
- low blood pressure and weak pulse because the volume of blood your heart is pumping is reduced
- extended neck veins because they’re having a hard time returning blood to your heart
- a rapid heartbeat combined with muffled heart sounds due to the expanding layer of fluid inside your pericardium
Your doctor will conduct further tests to confirm a cardiac tamponade diagnosis. One such test is an echocardiogram, which is an ultrasound of your heart. It can detect whether the pericardium is distended and if the ventricles have collapsed due to low blood volume. Your chest X-rays may show an enlarged, globe-shaped heart if you have cardiac tamponade. Other diagnostic tests may include:
- a thoracic CT scan to look for fluid accumulation in your chest or changes to your heart
- a magnetic resonance angiogram to see how blood is flowing through your heart
- an electrocardiogram to assess your heartbeat
Cardiac tamponade is a medical emergency that requires hospitalization. The treatment of cardiac tamponade has two purposes. It should relieve pressure on your heart and then treat the underlying condition. Initial treatment involves your doctor making sure you’re stabilized.
Your doctor will drain the fluid from your pericardial sac, typically with a needle. This procedure is called pericardiocentesis. Your doctor may perform a more invasive procedure called a thoracotomy to drain blood or remove blood clots if you have a penetrating wound. They may remove part of your pericardium to help relieve pressure on your heart.
You’ll also receive oxygen, fluids, and medications to increase your blood pressure.
Once the tamponade is under control and your condition stabilizes, your doctor may perform additional tests to determine the underlying cause of your condition.
The long-term outlook depends on how quickly the diagnosis can be made, the underlying cause of the tamponade, and any subsequent complications. Your outlook is fairly good if the cardiac tamponade is quickly diagnosed and treated.
Your long-term outlook greatly depends on how quickly you get treatment. Seek medical treatment immediately if you think you have this condition.
- Markiewicz, W., et al. (1986, June). Cardiac tamponade in medical patients: treatment and prognosis in the echocardiographic era.
- Pericardiocentesis. (2014, December). http://www.mountsinai.org/patient-care/health-library/treatments-and-procedures/pericardiocentesis
- Ristić, A. R., et al. (2014, July 7). Triage strategy for urgent management of cardiac tamponade: A position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. http://eurheartj.oxfordjournals.org/content/early/2014/06/20/eurheartj.ehu217.full
- Spodick, D. H. (2003, August 14). Acute cardiac tamponade. http://www.nejm.org/doi/full/10.1056/NEJMra022643