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Cardiac Tamponade

Alternative names - Tamponade; Pericardial tamponade

In cardiac tamponade, a rapid, unchecked rise in intrapericardial pressure impairs diastolic filling of the heart. The rise in pressure usually results from blood or fluid accumulation in the pericardial sac.

If fluid accumulates rapidly, this condition is commonly fatal and necessitates emergency lifesaving measures. Slow accumulation and rise in pressure, as in pericardial effusion associated with cancer, may not produce immediate symptoms because the fibrous wall of the pericardial sac can gradually stretch to accommodate 1 to 2 L of fluid.

Causes

Increased intrapericardial pressure and cardiac tamponade may be idiopathic (Dressler's syndrome) or may result from the following conditions:

• effusion (in cancer, bacterial infections, tuberculosis and, rarely, acute rheumatic fever)
• hemorrhage from trauma (such as gunshot or stab wounds of the chest and perforation by a catheter during cardiac or central venous catheterization or after cardiac surgery)
• hemorrhage from nontraumatic causes (such as rupture of the heart or great vessels or anticoagulant therapy in a patient with pericarditis)
• acute myocardial infarction (MI) .
• uremia.

Signs and symptoms

• Discomfort, sometimes relieved by sitting upright or leaning forward.
• Jugular venous distention
• Pulsus paradoxus
• Muffled heart sounds
• Chest pain
• Anuria
• Weakness
• Skin pale, gray or blue
• Palpitations
• Drowsiness

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.

First Aid

If recognized, call for help and arrange for immediate transport to advanced medical care. MEDEVAC in wilderness first aid situations is indicated. If the patient's heart stops, CPR should be initiated immediately, although patient outcomes for out-of-hospital, tamponade-related arrest are extremely low.

Treatment

The goal of treatment is to relieve intrapericardial pressure and cardiac compression by removing accumulated blood or fluid. Pericardiocentesis (needle aspiration of the pericardial cavity) or surgical creation of an opening dramatically improves systemic arterial pressure and cardiac output with aspiration of as little as 25 ml of fluid. Such treatment necessitates continuous hemodynamic and ECG monitoring in the intensive care unit.

Trial volume loading with temporary LV. normal saline solution with albumin and perhaps an inotropic drug, such as isoproterenol or dopamine, is necessary to maintain cardiac output in the hypotensive patient.

Prevention

Many cases are not preventable. Awareness of your personal risk factors may allow early diagnosis and treatment.