Pregnancy SmartSite^TM

Cardiac tamponade

Heart - front viewHeart - front view
PericardiumPericardium
Cardiac tamponadeCardiac tamponade

Tamponade; Pericardial tamponade; Pericarditis - tamponade

Definition

Cardiac tamponade is pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle and the outer covering sac (pericardium) of the heart.

Causes

In this condition, blood or fluid collects in the sac surrounding the heart. This prevents the heart ventricles from expanding fully. The excess pressure from the fluid prevents the heart from working properly. As a result, the body does not get enough blood.

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 10,000 people.

Symptoms

Symptoms may include:

Anxiety, restlessness
Breathing problems
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

Echocardiogram is the test of choice to help make the diagnosis. This test may be done at the bedside in emergency cases.

A physical exam may show:

Blood pressure that falls when breathing deeply
Rapid breathing
Heart rate over 100 (normal is 60 to 100 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:

Treatment

Cardiac tamponade is an emergency condition that needs to be treated in the hospital.

The fluid around the heart must be drained as quickly as possible. A procedure that uses a needle to remove fluid from the tissue that surrounds the heart will be done.

A surgical procedure to cut and remove part of the covering of the heart may also be done. This is known as surgical pericardiectomy or pericardial window.

Fluids are given to keep blood pressure normal until the fluid can be drained from around the heart. Medicines that increase blood pressure may also help keep the person alive until the fluid is drained.

Oxygen may be given to help reduce the workload on the heart by decreasing tissue demands for blood flow.

The cause of tamponade must be found and treated.

Outlook (Prognosis)

Death due to cardiac tamponade can occur quickly if the fluid or blood is not removed promptly from within the pericardium.

The outcome is often good if the condition is treated promptly. However, tamponade may come back.

Possible Complications

Complications may include:

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) if symptoms develop. Cardiac tamponade is an emergency condition that needs immediate medical attention.

Prevention

Many cases can't be prevented. Knowing your personal risk factors may help you get early diagnosis and treatment.

References

Hoit BD, Oh JK. Pericardial diseases. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 62.

LeWinter MM, Cremer PC, Klein AL. Pericardial diseases. In: Libby P, Bonow RO, Mann DL, Tomaselli, GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 86.

Mallemat HA, Tewelde SZ. Pericardiocentesis. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 16.

Schedule An Appointment

Review Date: 5/13/2024

Reviewed By: Mary C. Mancini, MD, PhD, Cardiothoracic Surgeon, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.