How does cardiac tamponade affect the heart

The treatment of cardiac tamponade has two purposes. It should relieve pressure on your heart and then treat the underlying condition.

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. 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. Pericardiocentesis or a pericardial tap is a test used to diagnose problems with your pericardium, the double-layered membrane that surrounds your…. Bacterial pericarditis is an infection of the pericardium, which is a thin membrane that protects your heart. Read more about how to treat this…. Constrictive pericarditis is chronic inflammation of the pericardium, which is a sac-like membrane that surrounds the heart.

Swan-Ganz catheterization helps determine whether you have certain heart and lung abnormalities. Editorial team. Cardiac tamponade.

Cardiac tamponade can occur due to: Dissecting aortic aneurysm thoracic End-stage lung cancer Heart attack acute MI Heart surgery Pericarditis caused by bacterial or viral infections Wounds to the heart Other possible causes include: Heart tumors Underactive thyroid gland Kidney failure Leukemia Placement of central lines Radiation therapy to the chest Recent invasive heart procedures Systemic lupus erythematosus Dermatomyositis Heart failure Cardiac tamponade due to disease occurs in about 2 out of 10, people.

Symptoms may include: Anxiety , restlessness Sharp chest pain that is felt in the neck, shoulder, back, or abdomen Chest pain that gets worse with deep breathing or coughing Problems breathing Discomfort, sometimes relieved by sitting upright or leaning forward Fainting , lightheadedness Pale, gray, or blue skin Palpitations Rapid breathing Swelling of the legs or abdomen Jaundice Other symptoms that may occur with this disorder: Dizziness Drowsiness Weak or absent pulse.

Exams and Tests. A physical exam may show: Blood pressure that falls when breathing deeply Rapid breathing Heart rate over normal is 60 to beats per minute Heart sounds are only faintly heard through a stethoscope Neck veins that may be bulging distended but the blood pressure is low Weak or absent peripheral pulses Other tests may include: Chest CT or MRI of chest Chest x-ray Coronary angiography ECG Right heart catheterization.

Cardiac tamponade is an emergency condition that needs to be treated in the hospital. The cause of tamponade must be found and treated. Outlook Prognosis. Possible Complications. Several signs may be present during examination depending on the time of fluid accumulation. Other clinical signs in a patient with cardiac tamponade include tachycardia, pulsus paradoxus, decreased electrocardiographic voltage with electrical alternans and an enlarged cardiac silhouette on chest X-ray with slow-accumulating effusions [].

The pathophysiological and haemodynamic explanation for the above-mentioned findings is as follows. During fluid accumulation, left- and right-sided atrial and ventricular diastolic pressures rise, and equalise the pressure similar to the pericardial sac mmHg. The equalisation is closest during inspiration. Thus, pericardial pressure dictates intracavitary pressure leading to a progressive decline in cardiac volumes. The decreased preload accounts for the reduced stroke volume and compensatory increased contractility, and tachycardia is not enough to maintain stroke volume, thus leading to reduced cardiac output.

Since the filling pressure in the right side of the heart is lower than in the left side of the heart, filling pressure increases more rapidly in the right than in the left side of the heart. Normally, the intrathoracic pressure decreases during inspiration which allows blood to flow easily into the right heart. Conversely, the left heart filling decreases during inspiration, as the intrapericardial volume is fixed. During expiration, the intrathoracic pressure increases which leads to less right heart filling and augments filling of the left heart chambers.

When fluid accumulates in the pericardial space, the intrapericardial pressure increases. This leads to a compression of the right heart, increasing the right heart pressure.

Thus, the right heart filling is now relying more heavily on the decreased intrathoracic pressures during inspiration to fill, exaggerating the blood pressure change. The interventricular septum shifts to the left during inspiration and encroaches on the left ventricle, leading to a further reduction in stroke volume of the left ventricle [11].

The underlying process for the development of tamponade is a marked reduction in diastolic filling, which results when transmural distending pressures become insufficient to overcome increased intrapericardial pressures. Tachycardia is the initial cardiac response to these changes to maintain the cardiac output. Systemic venous return is also altered during tamponade.

Because the heart is compressed throughout the cardiac cycle due to the increased intrapericardial pressure, systemic venous return is impaired and right atrial and right ventricular collapse occurs. Because the pulmonary vascular bed is a vast and compliant circuit, blood preferentially accumulates in the venous circulation, at the expense of left ventricular filling.

This results in reduced cardiac output and venous return. The amount of pericardial fluid needed to impair diastolic filling of the heart depends on the rate of fluid accumulation and the compliance of the pericardium. The symptoms of cardiac tamponade vary with the length of time over which pericardial fluid accumulates. As depicted in Figure 1, a rapid accumulation of fluid in the pericardium quickly leads to a steep rise in pericardial pressure, whereas a slower accumulation of fluid takes longer to reach critical or symptomatic pericardial pressure [12,13].

Thus, the haemodynamic impact of an effusion ranges from none or mild to cardiogenic shock which leads to a clinical presentation ranging from acute to subacute. Acute or rapid cardiac tamponade is a form of cardiogenic shock and occurs within minutes.

The symptoms are sudden onset of cardiovascular collapse and may be associated with chest pain, tachypnoea, and dyspnoea. The decline in cardiac output leads to hypotension and cool extremities.

The jugular venous pressure rises which may show as venous distension at the neck and head. Acute cardiac tamponade is usually caused by bleeding due to trauma, aortic dissection or is iatrogenic. Chronic fluid accumulation or subacute cardiac tamponade is characterised by the patients being more asymptomatic in the early phase but, when the pressure rises above the pericardial stretch point Figure 1 , they complain of dyspnoea, chest discomfort, peripheral oedema, fatigue, or tiredness, all symptoms attributable to increased pericardial pressure and limited cardiac output.

Prompt diagnosis is the key to reducing the mortality risk for patients with cardiac tamponade. Although cardiac tamponade is a clinical diagnosis, echocardiography Figure 2 provides useful information and is the cornerstone during evaluation availability, bedside, and treatment. However, cardiac tamponade is associated with a variety of abnormalities that lead to changes on the electrocardiogram ECG , chest X-ray, and on echocardiography.

Abnormalities of tamponade on the ECG are typically low voltage and electrical alternans. However, reduced voltage can also be seen among other conditions such as infiltrative myocardial disease and emphysema, whereas electrical alternans characterised by beat to beat alterations in the QRS complex caused by swinging of the heart is specific, but not sensitive for tamponade. In general, an enlarged cardiac silhouette is neither sensitive nor specific for the diagnosis of cardiac tamponade.

People with certain medical conditions are more likely than the general population to experience cardiac tamponade, including people with:. As cardiac tamponade can result in shock or death, it always requires emergency medical treatment.

This treatment involves draining excess fluid from around the heart. According to some research , doctors should choose minimally invasive procedures, such as pericardiocentesis, as the first treatment option. Such options carry a less significant risk of complications and have lower mortality rates.

However, more complicated cases of cardiac tamponade will often require surgery, including a thoracotomy. Once the person is stable, the doctor will need to determine and treat the underlying cause of the cardiac tamponade to prevent further complications. People with a non-cancerous cause of cardiac tamponade have a mortality rate of less than 15 percent. Cases in which cancer is the underlying cause have an estimated mortality rate of 80 percent within 1 year.

Mortality rates are also higher among those who have sepsis , acute kidney injury, or chest injury. Prompt diagnosis and early treatment significantly improve the outlook for people with cardiac tamponade. Without treatment, the condition is fatal. It is not possible to prevent all cases of cardiac tamponade. However, people can reduce their risk by doing the following:. Cardiac tamponade is an uncommon but severe medical condition that can result in shock or death. It is vital that anyone who suspects that they have cardiac tamponade seeks emergency treatment.