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Cardiac Tamponade, Also Known As Pericardial Tamponade, Is An
Cardiac Tamponade, Also Known As Pericardial Tamponade, Is An
in which fluid accumulates in the pericardium (the sac in which the heart is enclosed). If
the fluid significantly elevates the pressure on the heart it will prevent the heart's
ventricles from filling properly. This in turn leads to a low stroke volume. The end result
is ineffective pumping of blood, shock, and often death.
Incidence :
Frequency
United States
The incidence of cardiac tamponade is 2 cases per 10,000 population in the United States.
Approximately 2% of penetrating injuries are reported to result in cardiac tamponade.
Mortality/Morbidity
Cardiac tamponade is a medical emergency. Early diagnosis and treatment are crucial to reduce
morbidity and mortality. Untreated, it is rapidly and universally fatal.
Sex
In children, cardiac tamponade is more common in boys than in girls, with a male-to-female ratio of
7:3. In adults, cardiac tamponade appears to be slightly more common in men than in women. The
male-to-female ratio of 1.25:1 observed at author's referral center based on the International
Classification of Diseases (ICD) code 423.9. However, a male-to-female ratio of 1.7:1 is observed at
another level 1 trauma center.
Age
Cardiac tamponade related to trauma or HIV is more common in young adults, whereas tamponade
due to malignancy and/or renal failure occurs more frequently in elderly individuals.
Causes:
Cardiac tamponade occurs when the pericardial space fills up with fluid faster than the
pericardial sac can stretch. If the amount of fluid increases slowly (such as in
hypothyroidism) the pericardial sac can expand to contain a liter or more of fluid prior to
tamponade occurring. If the fluid occurs rapidly (as may occur after trauma or myocardial
rupture) as little as 100 ml can cause tamponade.
hypothyroidism,
physical trauma (either penetrating trauma involving the pericardium or blunt chest
trauma),
cancer, uraemia
cardiac surgery
One of the most common settings for cardiac tamponade is in the first 24 to 48 hours
after heart surgery. After heart surgery, chest tubes are placed to drain blood. These chest
tubes, however, are prone to clot formation. When a chest tube becomes occluded or
clogged, the blood that should be drained can accumulate around the heart, leading to
tamponade. Nurses will frequently milk clots from the tubes, or strip the tubes, but even
with these efforts chest tubes can become clogged. Thus, after heart surgery it is critical
to be on the watch for chest tube clogging.
Pathophysiology:
Clinical
History
Symptoms vary with the underlying cause and the acuteness of the tamponade. Patients with acute
tamponade may present with dyspnea, tachycardia, and tachypnea. Cold and clammy extremities from
hypoperfusion are also observed in some patients.
A comprehensive review of the patient's history usually helps identify the probable etiology of a
pericardial effusion, which may result in cardiac tamponade.
Patients with systemic or malignant disease present with weight loss, fatigue, or anorexia.
Chest pain may be the presenting symptom in patients with pericarditis or myocardial
infarction.
Musculoskeletal pain or fever may be present in patients with an underlying connective tissue
disorder.
A history of renal failure can lead to a consideration of uremia as a cause of pericardial
effusion.
Careful review of a patient's medications may indicate drug-related lupus leading to a
pericardial effusion.
Recent cardiovascular surgery, coronary intervention, or trauma can lead to the rapid
accumulation of pericardial fluid and tamponade.2
Recent pacemaker lead implantation or central venous catheter insertion can lead to the rapid
accumulation of pericardial fluid and tamponade.3
Consider HIV-related pericardial effusion and tamponade if the patient has a history of
intravenous drug abuse or opportunistic infections.
Inquire about chest wall radiation (ie, for lung, mediastinal, or esophageal cancer).
Inquire about symptoms of night sweats, fever, and weight loss, which may be indicative of
tuberculosis.
Physical
Distended neck veins are a common feature in patients with tamponade. Evidence of chest wall injury
may be present in trauma patients. Tachycardia, tachypnea, and hepatomegaly are observed in more
than 50% of patients with cardiac tamponade, and diminished heart sounds and a pericardial friction
rub are present in approximately one third of patients.
Anxiety, restlessness
Chest pain
o Radiating to the neck, shoulder, back, or abdomen
o Sharp, stabbing
o Worsened by deep breathing or coughing
Difficulty breathing
Discomfort, sometimes relieved by sitting upright or leaning forward
Fainting, light-headedness
Pale, gray, or blue skin
Palpitations
Rapid breathing
Swelling of the abdomen or other areas
Dizziness
Drowsiness
Low blood pressure
Weak or absent pulse
There are no specific laboratory tests that diagnose tamponade. Echocardiogram is the
first choice to help establish the diagnosis.
Signs:
Blood pressure may fall (pulsus paradoxical) when the person inhales
deeply
Breathing may be rapid (faster than 12 breaths in an adult per minute)
Heart rate may be over 100 (normal is 60 to 100 beats per minute)
Heart sounds faint during examination with a stethoscope
Neck veins may be abnormally extended (distended) but the blood
pressure may be low
Peripheral pulses may be weak or absent