What is Cardiac Tamponade?

Sudden chest pain, shortness of breath, dizziness or altered mental status are signs of an underlying heart or lung-related problem. While there can be numerous reasons, cardiac tamponade is an emergency that cannot be ignored. Timely intervention can save a life.

Cardiac tamponade is a medical emergency in which fluid accumulates around the heart. This fluid does not allow the heart to fully relax, thus affecting the blood flow to the rest of the body.

The heart is surrounded by a sac called the pericardium. As a muscle, when the heart contracts, it forces blood out to the rest of the body andwhen it relaxes, blood fills up the heart again. This is a cycle that repeats so that our body gets enough oxygen from the blood. Presence of fluid around the heart makes it difficult for it to contract and relax, thus compromising blood flow to the rest of the body.

Overview

Knowing that a tamponade might happen could help someone in their time of need. The risk factors for developing a tamponade will be explained as well as what symptoms to look out for and when to take them to an emergency physician for prompt care.

Causes of cardiac tamponade

A number of reasons can cause the fluid accumulation, but the most common one is emergency reslulting in a traumatic wound (like a stab wound) to the chest where blood quickly builds up in the space. Even a small volume of rapid fluid build-up is dangerous. On the contrary, a slow build-up of large volumes of fluid in conditions like infections, autoimmune diseases and inflammation would not be immediately life-threatening. However, if a person with these conditions develops sudden onset shortness of breath or chest pain, suspect a tamponade.

Signs and symptoms of cardiac tamponade

The most common symptoms are the ones mentioned. There are three main signs that a doctor might elicit to confirm tamponade:

• Low blood pressure (hypotension)
• Distended neck veins (jugular venous distension)
• Muffled heart sounds 

Management and treatment for cardiac tamponade

In an out-of-hospital setting, make sure the person receives enough blood to the rest of their body. This can be done by leg elevation, providing oxygen through a mask and giving intravenous fluids all while transfering the individual to an emergency medical centre.

Inside a hospital, the above measures are taken care of while decompressing the heart simultaneously. This is done by placing a needle just below the chest in the middle and aspirating the fluid out (needle pericardiocentesis) bedside with or without the help of an echocardiogram to visualise correct placement. Furthermore, the patient might recieve a tube in place for continuous drainage of fluid, have the pericardial sac removed or have a surgery to create a window  which can be considered depending on the cause of the fluid accumulation.

Diagnosis of cardiac tamponade

In a hospital setting, clinical diagnosis is enough for emergent intervention. However, certain tests can confirm the presence of fluid around the heart. With all this fluid, the heart is essentially a floating mass inside a balloon. This can be visualised on a chest X-Ray or an echocardiogram (like an ultrasound of the heart). If an ECG is done, the electrical activity shows alternate waxing and waning-suggesting irregular electrical impulses due to the floating heart inside the fluid.

Risk factors

Risk factors and underlying conditions include:

• Infections: tuberculosis, myocarditis
• Autoimmune diseases: Lupus, Rheumatoid arthritis
• Cancer-related: lung cancer, radiation therapy
• Inflammation: pericarditis (inflammation of the pericardium)

Complications

Once a tamponade has been suspected, a team of physicians and nursing staff have to be alerted to stabilise the patient because if there is less blood (and oxygen) flow throughout the body it can compromise the person’s long-term health. 

The fluid can back up in the lung (pulmonary oedema), compromise blood flow to the rest of the body (cardiogenic shock) or lead to death if not attended to immediately.

FAQs

Can cardiac tamponade be prevented?

Although there is no vaccine to prevent tamponade, the best way to avoid this complication is by minimizing the risk factors like regular treatment of infections and immune disorders. It is also difficult to predict a tamponade, so educating caretakers about the possibility and having a well-equipped cardiac emergency team is necessary to improve patient outcomes.

How common is cardiac tamponade?

In the overall population, the incidence is not known. However, certain cohorts of risk factors have a higher chance of developing a cardiac tamponade. These are:

• HIV positive
• End Stage Kidney Disease
• Tuberculosis
• Congestive Heart Failure
• Carcinomas
• Lupus
• Traumatic injury to the center of the chest

When should I see a doctor?

If you develop any chest pain, shortness of breath or palpitations, seek medical care immediately. 

Summary

Cardiac tamponade is a medical emergency that occurs when fluid accumulates around the heart, making it difficult for the heart to contract and relax properly, thus compromising blood flow to the rest of the body. Traumatic wounds to the chest, infections, autoimmune diseases, and inflammation are some of the reasons that can lead to fluid accumulation. The common symptoms of cardiac tamponade include chest pain, shortness of breath, dizziness, and altered mental status. Low blood pressure, distended neck veins, and muffled heart sounds are some of the signs that a doctor might elicit to confirm tamponade. Management and treatment include providing enough blood to the rest of the body, leg elevation, oxygen through a mask, intravenous fluids and transfer to an emergency medical centre. The diagnosis of cardiac tamponade can be done through chest X-rays, echocardiograms, and electrocardiograms. Complications of cardiac tamponade include pulmonary oedema, cardiogenic shock or death if not attended to immediately.