ENLmedical.com: Conditions And Concerns: Medical Encyclopedia: Cardiac tamponade

Cardiac tamponade

Causes and Risks:
Cardiac tamponade may be related to pericarditis that results from bacterial or viral infections. It may also be related to heart surgery, dissecting aortic aneurysm (thoracic), and acute MI .

Blood or fluid collects in the pericardium. This prevents the ventricles from expanding fully, so they cannot adequately fill or pump blood.

Risks for cardiac tamponade include many disorders, such as pericarditis, heart tumors, kidney failure , recent heart attack , injury to the pericardium from surgery or accident, recent invasive heart procedures, radiation therapy to the chest, hypothyroidism , and systemic lupus erythematosus .

Cardiac tamponade occurs in approximately 2 out of 10,000 people.

Prevention:
Many cases are not preventable. Awareness of risk can allow early diagnosis and treatment.

Symptoms:

anxiety , restlessness
posture is upright or leaning forward
difficulty breathing
rapid breathing
fainting , lightheadedness
chest pain
- radiating to the neck, shoulder, back or abdomen
- sharp, stabbing
- worsened by deep breathing or coughing
swelling of the abdomen or other areas
skin pale, gray or blue

Additional symptoms that may be associated with this disease:

Signs and Tests:
There are no specific laboratory tests that diagnose tamponade. However, the heart will sound uncharacteristically faint during examination with a stethoscope ( auscultation ) . Peripheral pulses may be weak or absent. Neck veins may be distended but the blood pressure may be low. The heart rate may be over 100 (normal is 60 to 100 beats per minute), and breathing may be rapid (faster than 12 breaths in an adult per minute). The blood pressure may fall (pulsus paradoxical) when the person inhales deeply.

Fluid in the pericardial sac may show on:
- chest X-ray
- echocardiogram
- chest CT or MRI of chest
- coronary angiography (may show other changes also)
ECG changes include low voltage wave forms.

Treatment:
Cardiac tamponade is an emergency condition that requires hospitalization. Treatment is aimed at saving the patient's life, improving heart function, and treating of the tamponade.

Analgesics such as morphine, and diuretics such as furosemide (see furosemide - oral), may stabilize the condition until the fluid can be removed.

Bedrest with the head slightly elevated minimizes the workload on the heart and may be recommended until the condition is stable.

Oxygen reduces the workload on the heart by decreasing tissue demands for blood flow.

The cause of the tamponade must be identified and treated. Treatment of the cause may include medications such as antibiotics, and surgical repair of injury.

Removal of excess fluid from the sac ( pericardiocentesis ) may relieve symptoms and can be life-saving.

Cutting and/or removal of part of the pericardium (surgical pericardiectomy) may be required if scarring is a cause of tamponade.

Prognosis:
Tamponade is life threatening if untreated. The outcome is often good if the condition is treated promptly, but tamponade may recur.

Complications:

Call Your Healthcare Provider:
Go to the emergency room or call the local emergency number (such as 911) if symptoms develop. Cardiac tamponade is an emergency condition requiring immediate attention!