Cardiac Tamponade

What is cardiac tamponade?

Cardiac tamponade is a life-threatening condition caused by too much fluid around the heart. The heart lies inside a tissue sac called the pericardium. Fluid that collects in the pericardial sac can put so much pressure on the heart that it keeps the heart from relaxing completely between heartbeats. The pressure keeps the heart from filling completely with blood before the next heartbeat. This lessens the amount of blood pumped by the heart. Severe pericardial fluid pressure can cause a drop in blood pressure, shock, abnormal heart rhythms, and death.

What is the cause?

There are several problems that can cause cardiac tamponade.

Sudden bleeding into the heart sac may be caused by:

• an injury to the heart sac
• a tear in the heart muscle during or after a heart attack
• a tear in the large blood vessel leading away from the heart (the aorta)

A gradual buildup of fluid around the heart may be caused by:

• an infection or inflammation of the heart sac (pericarditis)
• cancer in or near the heart
• kidney failure

What are the symptoms?

The symptoms may be very mild. Symptoms may include:

• shortness of breath
• low blood pressure
• fast heart rate
• swollen veins in the neck or the arms
• fainting spells
• weakness and feeling bad

How is it diagnosed?

Your healthcare provider will ask about your medical history and symptoms and examine you. Your provider will measure your blood pressure as you breathe. A large change in blood pressure between the end of one breath and the start of the next breath is a sign of cardiac tamponade.

You may have an echocardiogram. This test uses ultrasound waves to look for fluid in the sac around the heart. As the pressure from the fluid increases, there are changes in the way the heart fills and pumps blood. These changes help your provider know if you have cardiac tamponade.

Sometimes a coronary angiogram may be done. For this test your healthcare provider places a long, thin, flexible tube (catheter) into a blood vessel in your groin and up to your heart. The catheter is attached to a device that measures blood flow and blood pressure in different places in the heart and blood vessels.

How is it treated?

Severe cardiac tamponade must be treated right away because it can cause death. Some or all of the pericardial fluid must be removed. The fluid may be removed with a needle or surgery.

• When a needle is used for drainage, an area of your chest is numbed with a shot of anesthetic. Then a needle is put through the chest wall over the heart or through the area just under the breastbone. The needle punctures the pericardial sac around the heart. Once the puncture is made, a tube is put in to drain the fluid. Sometimes a special needle is used to get small samples (biopsies) of the pericardium for examination by microscope.
• When surgery is done, you are given general anesthesia. General anesthesia relaxes your muscles, puts you to sleep, and keeps you from feeling pain. Then your healthcare provider will make a cut in your chest and open the pericardial sac to drain some of the fluid. A small area of pericardium may be removed. A drain may be left in place for several days to help prevent another buildup of fluid.

Some of the fluid removed from the pericardium will be sent to the lab to be checked for blood cells, cancer cells, or infection.

Symptoms usually get better quickly after the fluid is removed. The drainage tube is usually left in place for a day or two and then removed.

Your healthcare provider will also treat any medical problem that may be causing a fluid buildup.

How can I take care of myself?

Follow the treatment plan your healthcare provider prescribes.

Ask your healthcare provider:

• how and when you will hear your test results
• how long it will take to recover
• what activities you should avoid
• how to take care of yourself at home and what symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

Contact your healthcare provider if you have any questions or your symptoms seem to be getting worse.