Cardiac tamponade is a scientific syndrome brought on by the accumulation of fluid in the pericardial area, leading to minimized ventricular filling and subsequent hemodynamic compromise. The condition is a medical emergency, the complications of that include pulmonary edema, shock, and death.
What Causes Cardiac Tamponade?
Cardiac tamponade is usually the result of penetration of the pericardium, which is the thin, double-walled sac that surrounds your heart. The cavity around your heart can fill with adequate blood or other bodily fluids to compress your heart. As the fluid presses on your heart, less and less blood can get in. Less oxygen-rich blood is pumped to the rest of your body as an outcome. The lack of blood getting to the heart and the rest of your body can ultimately trigger shock, organ failure, and heart attack.
The causes of pericardial penetration or fluid build-up might consist of:
- gunshot or stab wounds
- blunt injury to the chest from a car or industrial mishap
- unintentional perforation after a cardiac catheterization, angiography, or insertion of a pacemaker
- punctures made throughout positioning of a central line, which is a type of catheter that administers fluids or medications
- cancer that has spread to the pericardial sac, such as breast or lung cancer
- a burst aortic aneurysm
- pericarditis, an inflammation of the pericardium
- lupus, an inflammatory disease in which the body immune system wrongly assaults healthy tissues
- high levels of radiation to the chest
- hypothyroidism, which increases the danger for cardiovascular disease
- a heart attack
- kidney failure
- infections that impact the heart
Symptoms and Signs of Cardiac Tamponade
Symptoms differ with the acuteness and underlying cause of the tamponade. Patients with acute tamponade might provide with dyspnea, tachycardia, and tachypnea. Cold and clammy extremities from hypoperfusion are also observed in some patients. Other symptoms and signs may include the following:
- Elevated jugular venous pressure
- Pulsus paradoxus
- Chest pressure
- Decreased urine output
Trigger medical diagnosis is essential to reducing the death threat for patients with cardiac tamponade. Although echocardiography provides beneficial info, cardiac tamponade is a scientific medical diagnosis. Echocardiography can be used to picture ventricular and atrial compression abnormalities as blood cycles through the heart. The following might be observed with 2-dimensional (2-D) echocardiography:
- An echo-free space posterior and anterior to the left ventricle and behind the left atrium
- Early diastolic collapse of the right ventricular complimentary wall
- Late diastolic compression/collapse of the right atrium
- Swinging of the heart in the pericardial sac
- Left ventricular pseudohypertrophy
- Inferior vena cava myriad with minimal or no collapse with motivation
- A higher than 40% relative inspiratory augmentation of blood circulation throughout the tricuspid valve
- A higher than 25% relative reduction in inspiratory flow across the mitral valve
Removal of pericardial fluid is the definitive therapy for tamponade and can be done utilizing the following three techniques:
- An emergency subxiphoid percutaneous drain
- Pericardiocentesis (with or without echocardiographic assistance).
- Percutaneous balloon pericardiotomy.
- The role of medication therapy in cardiac tamponade is restricted.
Cardiac Tamponade Treatment
Cardiac tamponade is a medical emergency that needs hospitalization. The treatment of cardiac tamponade has two purposes. It needs to ease pressure on your heart and then deal with the underlying condition. Preliminary treatment includes your physician making sure you’re stabilized.
The role of medication treatment in cardiac tamponade is limited.
Your medical professional will drain the fluid from your pericardial sac, usually with a needle. This procedure is called pericardiocentesis. Your physician may perform a more invasive treatment 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 ease pressure on your heart.
You’ll likewise receive oxygen, fluids, and medications to increase your blood pressure.
Once the tamponade is under control, and your condition supports, your medical professional might carry out additional tests to identify the underlying reason for your health.
The long-lasting outlook depends upon how rapidly the medical diagnosis can be made, the underlying reason for the tamponade, and any subsequent problems. Your outlook is relatively good if the cardiac tamponade is rapidly detected and dealt with.
Your long-term outlook considerably depends on how rapidly you get treatment. Look for medical treatment immediately if you believe you have this condition.
Cardiac Tamponade: Question & Answers
Which factors affect the mortality risk of cardiac tamponade?
The overall death risk depends on the speed of diagnosis, the treatment provided, and the underlying reason for the tamponade. Without treatment, the condition is rapidly and generally deadly.
What are the phases of hemodynamic changes in cardiac tamponade?
Reddy et al describe 3 phases of hemodynamic changes in tamponade, as follows:
- Phase I – The build-up of pericardial fluid impairs relaxation and filling of the ventricles, needing a higher filling pressure; throughout this phase, the left and right ventricular filling pressures are higher than the intrapericardial pressure
- Phase II – With more fluid build-up, the pericardial pressure increases above the ventricular filling pressure, resulting in decreased cardiac output.
- Phase III – A further reduction in cardiac output takes place, which is due to the equilibration of pericardial and left ventricular (LV) filling pressures.
What is the underlying pathogenic process of cardiac tamponade?
The underlying process for the advancement of tamponade is a marked reduction in diastolic filling, which results when transmural distending pressures end up being insufficient to get rid of increased intrapericardial pressures. Tachycardia is the preliminary cardiac response to these changes to preserve the cardiac output.
What are the risk factors for cardiac tamponade in patients undergoing heart valve surgery?
In patients undergoing heart valve surgery, cardiac tamponade has actually been associated with any amount of pericardial effusion at the first postoperative transthoracic echocardiography as well as with mechanical valve replacement of the aortic or mitral valve.
What is the incidence of cardiac tamponade in the US?
The occurrence of cardiac tamponade is 2 cases per 10,000 population in the United States. Roughly 2% of penetrating injuries are reported to lead to cardiac tamponade.
What are the mortality rates for cardiac tamponade?
In addition to treatment for the tamponade, all patients must also get treatment for the condition’s underlying cause in order to prevent recurrence.
In a study of patients with cardiac tamponade, Cornily et al reported a 1-year mortality rate of 76.5% in patients whose tamponade was brought on by malignant disease, compared with 13.3% in patients without any deadly disease. The private investigators likewise kept in mind a median survival of 150 days in patients with malignant disease.
What are the symptoms of acute cardiac tamponade?
Symptoms differ with the acuteness and underlying cause of the tamponade. Patients with acute tamponade might provide with dyspnea, tachycardia, tachypnea, decreased urine output, and/or confusion. Cold and clammy extremities from hypoperfusion are likewise observed in some patients.
What is pulsus paradoxus in cardiac tamponade?
Pulsus paradoxus (or paradoxical pulse) is an exaggeration (12+ mm Hg or 9%) of the normal inspiratory reduction in systemic blood pressure.
What is the Kussmaul sign in cardiac tamponade?
This was described by Adolph Kussmaul as a paradoxical boost in jugular venous distention and pressure during motivation. The Kussmaul sign is usually observed in patients with constrictive pericarditis, but it is sometimes is observed in patients with effusive-constrictive pericarditis and cardiac tamponade.
What are the signs of dysphoria in cardiac tamponade?
Behavioral traits such as uneasy body language, unusual facial expressions, restlessness, and a sense of impending death were reported by Ikematsu in about 26% patients with cardiac tamponade.
What is included in the medical treatment of cardiac tamponade?
Cardiac tamponade is a medical emergency that needs immediate drainage of the pericardial fluid. Ideally, patients need to be kept an eye on in an intensive care unit. All patients ought to receive the following:
Volume growth with blood, plasma, dextran, or isotonic sodium chloride solution, as needed, to maintain sufficient intravascular volume – Sagristà-Sauleda et al noted considerable boost in cardiac output after volume expansion.
Bed rest with leg elevation – This may help increase venous return.
What is included in the inpatient care of cardiac tamponade?
After pericardiocentesis, leave the intrapericardial catheter in place after protecting it to the skin utilizing sterile treatment and attaching it to a closed drain system by means of a 3-way stopcock. Occasionally check for reaccumulation of fluid, and drain as required.
The catheter can be left in place for 1-2 days and can be utilized for pericardiocentesis. Serial fluid cell counts can be useful for helping to discover an approaching bacterial catheter infection, which might be catastrophic. If the leukocyte (WBC) count increases substantially, the pericardial catheter must be gotten rid of right away.
A Swan-Ganz catheter can be left in place for constant monitoring of hemodynamics and to examine the effect of reaccumulation of pericardial fluid. A repeat echocardiogram and a repeat chest radiograph must be performed within 24 hours.
Which specialist consultations are needed for the treatment of cardiac tamponade?
Assessments related to cardiac tamponade can include the following:
- Hemodynamically stable patients – Cardiologist
- Hemodynamically unsteady patients – Cardiologist, cardiothoracic surgeon
What is the definitive therapy for cardiac tamponade?
Removal of pericardial fluid, with or without echocardiographic guidance, is the definitive treatment for tamponade and can be done utilizing the following 3 techniques.
Which medications in the drug class Cardiovascular, Other are used in the treatment of Cardiac Tamponade?
By promoting beta-1 receptors in the heart, these representatives increase stroke volume and cardiac output.
Dobutamine is a synthetic catecholamine and a direct inotropic agent that promotes cardiac beta-receptors, with minimal boost in systemic vascular resistance.