What are the other Names for this Condition? (Also known as/Synonyms)

• Pericardial Effusion
• Pericardial Tamponade

What is Cardiac Tamponade? (Definition/Background Information)

• Cardiac Tamponade is a condition in which extra fluid builds up around the heart and compresses it
• Cardiac Tamponade prevents the heart from getting sufficient blood back from rest of the body. If the heart does not receive enough blood back from the body, it cannot pump blood out to the body again
• This can cause chest pain, shortness of breath, weakness, feeling faint, decreased urine output, and cold hands and feet in individuals affected by this condition
• Cardiac Tamponade is classified as:
  • Acute - develops over a short period of time; within minutes or hours
  • Subacute - develops over days to weeks
  • Localized - develops often following certain procedures such as pacemaker insertion, open-heart surgery, etc.
• Cardiac Tamponade is reported to occur in 1 out of every 5,000 individuals. The condition is more common in boys and men
• Being affected with HIV is generally the cause of Cardiac Tamponade in young adults, whereas malignancies and/or renal failure may contribute to the condition in the elderly
• Whereas some cases of Cardiac Tamponade occurrences appear to be idiopathic, end-stage renal disease, invasive heart/lung surgical procedures, tuberculosis, and collagen vascular disorders are reportedly some risk factors for this condition
• Electrocardiogram, echocardiography, and chest x-ray may be some procedures used to diagnose Cardiac Tamponade, apart from a physical exam and medical history evaluation
• The main course of treatment for Cardiac Tamponade is removal of the accumulated fluid. This can be accomplished either surgically or by inserting a needle guided by echocardiograph to drain the excess fluid
• While most cases of Cardiac Tamponade are not preventable, early diagnosis and prompt treatment can bring about a good prognosis

Who gets Cardiac Tamponade? (Age and Sex Distribution)

• Statistically, Cardiac Tamponade is seen to occur in 1 out of every 5,000 individuals; both children and adults are affected
• Among children, Cardiac Tamponade is more prevalent in boys than girls, with a male-to-female ratio of 7:3
• In adults, this condition appears to be slightly more common in men than women, with a male-to-female ratio ranging from 1.25-1.70:1 (average of 1.5:1)
• This heart condition is seen worldwide and all racial and ethnic groups are vulnerable

What are the Risk Factors for Cardiac Tamponade? (Predisposing Factors)

Some of the known risk factors for Cardiac Tamponade are:

• End-stage renal disease (causing complete failure of kidney function)
• Undergoing invasive procedures on the heart and lung
• Exposure to infections (such as tuberculosis): Sometimes, healthcare personnel may come in contact with infected individuals; or those living in regions where tuberculosis is prevalent, e.g., Asia and Mexico
• The period following an episode of heart attack
• Individuals with collagen vascular disorders such as lupus and rheumatoid arthritis
• Individuals with certain tumors, such as end-stage lung tumors

Cardiac Tamponade associated with trauma or HIV is more common in young adults, whereas tamponade due to malignancy and/or renal failure occurs more frequently in the elderly.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Cardiac Tamponade? (Etiology)

The causal factors of Cardiac Tamponade include:

• Physical trauma to the heart: Any kind of injury that might penetrate the protective layers of the heart can lead to an accumulation of blood between the layers causing tamponade
• Tumors: Those originating in the heart or others that form in certain body organs and spread to the heart
• Pericarditis: Infection of the pericardial layers, due to virus or bacteria
• Dissecting thoracic aortic aneurysm: It is a condition seen in individuals with a long history of high blood pressure. Blood is responsible for tearing the layers of blood vessels leaving the heart, leading to accumulation of blood between the layers of the heart, causing Cardiac Tamponade
• Renal failure
• Complications from a heart attack
• Iatrogenic factors: Cardiac Tamponade that develops during an invasive procedure (surgeries) on the heart or lung
• Hypothyroidism
• Collagen vascular disease
• Radiation therapy

Almost 14% of the cases of Cardiac Tamponade are of unknown origin (idiopathic).

What are the Signs and Symptoms of Cardiac Tamponade?

The signs and symptoms of Cardiac Tamponade differ, depending on whether the condition manifests suddenly or slowly. If it develops rapidly, the condition could be life-threatening, necessitating emergency medical treatment.

The signs and symptoms of Cardiac Tamponade that develops rapidly include:

• Chest pain
• Shortness of breath, faster breathing
• Very low blood pressure
• Cooling of hands and legs (the extremities), due to decreased blood supply to the region
• Decreased urine output

If Cardiac Tamponade establishes itself more slowly, the following symptoms may be observed:

• Tiredness
• Shortness of breath
• Chest pain or discomfort, such as feelings of heaviness/fullness of the chest
• Fainting, or feeling faint or dizziness
• Swelling in the lower legs

How is Cardiac Tamponade Diagnosed?

The clinical diagnosis of Cardiac Tamponade is usually based on the patient’s medical history and physical examination findings. A few supportive diagnostic tests include:

• Electrocardiogram (EKG): A test to help detect the electrical activity of the heart
• Chest x-ray: An x-ray image of the chest can show changes in the size of the heart due to fluid accumulation
• Echocardiography: A test that uses sound waves to detect any abnormal motion/s of the heart

Note: If echocardiography is available, then no other diagnostic modality is generally required.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Cardiac Tamponade?

The course of Cardiac Tamponade varies, being dependent upon the underlying cause and speed of onset. The complications may include:

• Even if there is a slow development of Cardiac Tamponade over a period of time, it can cause permanent damage to the heart. When not treated early, this can affect the pumping efficiency of the heart and also lead to pulmonary edema (fluid accumulation in the lungs)
• When sudden, Cardiac Tamponade can be fatal without treatment. In such a case, if early treatment is not provided, it can interfere with the pumping capacity of heart, eventually causing a heart failure leading to death

How is Cardiac Tamponade Treated?

The definitive treatment for Cardiac Tamponade is removal of the accumulated pericardial fluid, thereby relieving the pressure on the heart and allowing it to pump normally. The decision to remove the fluid in someone suspected with Cardiac Tamponade depends on the clinical assessment, echocardiographic findings, and the assessed risks of the removal procedure. However, patients with life-threatening condition require urgent fluid removal. The underlying cause should also be treated.

The fluid accumulated between the protective layers of heart is generally removed by employing one of these techniques:

• Catheter pericardiocentesis: In this procedure, the physician uses a needle to drain out the fluid, guided by an echocardiograph. It is the treatment of choice in most patients
• Surgical drainage: This is a surgical procedure performed under general anesthesia. An incision is made in the chest and the fluid is drained out from the heart
• Supportive care: Early detection of chronic Cardiac Tamponade with minimal or no evidence of heart failure may be treated conservatively. The condition is carefully monitored through serial echocardiographs and suitable hydration therapy is provided to treat the underlying cause

How can Cardiac Tamponade be Prevented?

Most of the cases of Cardiac Tamponade are not preventable.

• Active awareness of risk factors and symptoms to facilitate early detection can be life-saving
• In some cases, early detection and treatment of the condition that may cause Cardiac Tamponade may help in prevention

What is the Prognosis of Cardiac Tamponade? (Outcomes/Resolutions)

• Cardiac Tamponade, when diagnosed early and treated promptly can result in an excellent outcome
• However, the underlying cause leading to the condition might drive the outcome. For example, if an aggressive tumor is the leading cause of Cardiac Tamponade, the prognosis may not be predictable
• Since early detection of Cardiac Tamponade can be life-saving, it is important to identify the symptoms and risk factors and report them to the physician as early as possible

Additional and Relevant Useful Information for Cardiac Tamponade:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/heart-center/