Introduction

Cardiac tamponade is a serious medical condition in which fluid accumulates in the pericardium of the heart, putting pressure on the heart and making it difficult for blood to get pumped to other body tissues. The pericardium is a fibrous sac that surrounds the heart.

Cardiac tamponade prevents the chambers of the heart from getting filled properly.

 

 Key Facts & Statistics

Key facts and statistics that surround cardiac tamponade

• 2 out of 10,000 persons experience cardiac tamponade from other medical conditions.
• Most cases re usually emergencies- medical or traumatic emergency.
• The hallmark feature of cardiac tamponade, Beck’s Triad, occurs in only 10%-40% of persons with this  condition.
• When caused by malignant conditions, death rates can exceed 75% within 1 year.

 

 Risk Factors

What are the risk factors for cardiac tamponade?

• Congestive heart failure (CHF).
• Tuberculosis.
• Cancer.
• Surgical procedures performed on the heart.
• Human immuno-deficiency virus (HIV).
• Autoimmune conditions.

 

 Causes

What are the causes of cardiac tamponade?

The following are causes of cardiac tamponade:

•       Heart attack.
•       Tuberculosis.
•       Hypothyroidism.
•      Aortic dissection.
•  Chronic auto-immune conditions such as;

1.      Rheumatoid arthritis.
2.    Lupus.

• Trauma. Blunt trauma (car crash) or penetrating trauma (stab wounds).
• Heart cancer.

 

Some medical procedures can also cause cardiac tamponade, these are:

•  Surgical procedures performed near the pericardium or on the heart.
• Radiotherapy close to the heart or pericardium.
• Placing devices such as pacemakers.

 

 Signs & Symptoms

What are the signs and symptoms of cardiac tamponade?

• Beck’s Triad;

1. Hypotension (low blood pressure).
2.  Muffled heart sounds.
3. Jugular venous distension (JVD).

• Reflex tachycardia.
• Kussmaul’s sign (eleavated jugular venous pressure during inspiration).
• Chest pains.
• Altered mental status.
• Dizziness.
• Dyspnea.

 

 Diagnostic Procedures & Tests

How is cardiac tamponade diagnosed?

• Patient history-taking. This involves review of signs and symptoms which the patient presents with and personal medical history, among other relevant histories.
• Physical examination to:

1.    Check for the pulse rate.
2.    Check for blood pressure.
3.    Assess breathing.
4.   Listen to heart and breathing sounds.
5.  Check for pulsus paradoxus (systolic blood pressure decreasing by more than 10 mmHg during inspiration).

 

• In cardiac tamponade, there are three hallmark signs and symptoms that are referred to as Beck’s Triad. These are:

1.  Hypotension (low blood pressure).
2.  Muffled heart tones.
3. Jugular venous distension (JVD.

• However, Beck’s Triad is not always present.

 

Diagnostic tests

• These include:

1.  Echocardiogram (ECHO). In the absence of Beck’s Triad, bedside echocardiography should be performed when the diagnosis is suspected.
2.  Chest X-ray test.
3.  Catheterization of the heart. Cardiac catheterization shows elevaion and equalization of intrapericardial and diastolic pressures in all chambers of the heart. It also shows elevated JVP with loss of the x descent.
4. Computed tomography scan.
5.  Electrocardiogram (ECG). ECG shows electrical aternans and low voltage QRS complexes.

 

 Treatment and Management

How is cardiac tamponade treated?

• Treatment strategies:

1.   Pericardiocentesis. This procedure involves removing fluid from around the heart.
2.  Pericardiotomy.
3. Thoracotomy.

• Medications can be administered depending on the specific cause of cardiac tamponade.

 

 Differential Diagnosis

• Shock.
• Pulmonary embolism.
• Pneumothorax.
• Heart failure.
• Pleural effusion.
• Constrictive pericarditis.

 

 Complications

What are the complications of cardiac tamponade?

• Cardiogenic shock.
• Heart failure.
• Cardiac arrest.
• Death.

 

Prevention

How do we prevent cardiac tamponade?

Because of its association with factors such as illnesses and injuries, it becomes extremely difficult to predict and prevent cardiac tamponade.

To reduce the risk associated with developing cardiac tamponade:

•  Protect the chest from all kinds of trauma.
•  Go for health frequent check-ups after a cardiac event or when a surgical procedure has been conducted on the heart.