Cardiac Tamponade: Top Priorities for Managing Risks

May 2021

Cardiac tamponade is a life-threatening condition in which blood accumulates in the pericardial sac around the heart, causing compression of the heart. It may result from a number of different causes including trauma or cancer and is characterized by lightheadedness, dyspnea, chest pain and sometimes signs of shock.

A definitive diagnosis can be established through an echocardiogram or cardiac catheterization. Treatment usually includes surgical cardiectomy. This is best done early before symptoms progress to crush syndrome where myocardial dysfunction progresses to severe symptoms at risk for death. In those with more benign presentations with gradual development over time after surgery mortality rates are lower than 10%.

Cardiac tamponade is an acute condition that requires treatment by a surgeon in the cardiac catheterization laboratory. In cardiac catheterization lab, the pressure in the pericardial sac is measured. If it is greater than 20 mm Hg, a pericardiocentesis needle is passed through the chest wall and into the sac to remove approximately 2–3 ml of blood for examination. A small amount of air or saline may be injected to cause movement of blood within the sac, assisting in locating its wall. This procedure is called "water-seal" and allows calculation of a central venous pressure (the difference between diastolic pressure at left atrium and systolic pressure at left ventricle).

When cardiac tamponade is suspected, and pericardiocentesis is likely to be required, the patient may receive a bolus of 500 ml of isotonic fluid (such as saline) into the jugular or subclavian vein in order to open up the right heart chambers. This reduces resistance to insertion of a needle through the chest wall.

Tamponade can also present with signs and symptoms that do not include lightheadedness, such as syncope, due to lead point dysfunction or syncope due to electrical instability. The diagnosis then requires immediate pericardiocentesis if there are no contraindications to this procedure (surgery needed within a few hours).

The first documented case in the medical literature of tamponade was by du Laurens in 1647, who described a case of severe chest pain accompanied by fluid in the pericardial sac.

The incidence of cardiac tamponade is about 2–4% of all cases of cardiac arrest. The condition is more common in males (75%), those with advanced age and those who are seriously ill. It has an incidence rate of 3–18% after penetrating trauma, between 1 and 8% after blunt trauma and approximately 2% after surgery.

Cardiac tamponade is a life-threatening condition that can be very difficult to treat. There are two treatments most commonly used to relieve the pressure on the heart caused by the fluid accumulation. We'll go over each of these treatments so you can better understand your options and know which one would be best for your situation.

This surgery involves inserting a needle through the chest wall to release fluid from the pericardium (the sac that surrounds the heart). This operation is performed under general anesthesia. The duration of anesthesia ranges from one to twelve hours, depending on the amount of fluid removed. There is some risk to this surgery, especially if it is done in areas that are poorly controlled and/or swollen. It's also important to understand that there may be bleeding in these areas during or after surgery.

The following are potential complications that can occur after this surgery:

Bleeding - This can be a very serious complication because it may be difficult to stop. It's very important that the surgeon is aware of and controls the bleeding during surgery. The patient should also be informed about signs and symptoms of impending bleeding, namely bruises and pain in the chest. Bleeding can occur in areas other than the chest wall, like the abdomen or extremities, so tell your doctor right away if you feel any of these in your body. Bleeding is usually controlled by placing pressure on the wound with a bandage or other dressing for up to 24 hours after surgery.

A blood transfusion may be necessary in the event of a significant loss of blood.

Chest Pulling - Weakening or tearing of the muscles or bones that make up the chest wall is another potential complication, especially in patients with weak immune systems and/or a history of smoking. This complication is usually not serious and can be treated with rest, elevation and ice packs to reduce pain.

Hemorrhage - There is sometimes bleeding outside of the chest cavity during surgery even if the original bleed did not cause any symptoms. This post-operative hemorrhage can be life-threatening if it's not properly controlled by applying pressure to the area until the surgical team takes over.

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