Cardiac tamponade

Cardiac tamponade
Other namesPericardial tamponade
A very large pericardial effusion resulting in tamponade as a result of bleeding from cancer as seen on ultrasound. Closed arrow – the heart; open arrow – the effusion
SpecialtyCardiac surgery
SymptomsShortness of breath, weakness, lightheadedness, cough[1]
Usual onsetRapid or more gradual[2]
CausesCancer, kidney failure, chest trauma, pericarditis, tuberculosis[2][1]
Diagnostic methodSymptoms and ultrasound of the heart[2]
TreatmentDrainage (pericardiocentesis, pericardial window, pericardiectomy)[2]
Frequency2 per 10,000 per year (US)[3]

Cardiac tamponade, also known as pericardial tamponade (/ˌtæm.pəˈnd/[4]), is a compression of the heart due to pericardial effusion (the build-up of pericardial fluid in the sac around the heart).[2] Onset may be rapid or gradual.[2] Symptoms typically include those of obstructive shock including shortness of breath, weakness, lightheadedness, and cough.[1] Other symptoms may relate to the underlying cause.[1]

Common causes of cardiac tamponade include cancer, kidney failure, chest trauma, myocardial infarction, and pericarditis.[2][5] Other causes include connective tissues diseases, hypothyroidism, aortic rupture, autoimmune disease, and complications of cardiac surgery.[2][6] In Africa, tuberculosis is a relatively common cause.[1]

Diagnosis may be suspected based on low blood pressure, jugular venous distension, or quiet heart sounds (together known as Beck's triad).[2][1][7] A pericardial rub may be present in cases due to inflammation.[2] The diagnosis may be further supported by specific electrocardiogram (ECG) changes, chest X-ray, or an ultrasound of the heart.[2] If fluid increases slowly the pericardial sac can expand to contain more than 2 liters; however, if the increase is rapid, as little as 200 mL can result in tamponade.[2]

Tamponade is a medical emergency.[5] When it results in symptoms, drainage is necessary.[8] This can be done by pericardiocentesis, surgery to create a pericardial window, or a pericardiectomy.[2] Drainage may also be necessary to rule out infection or cancer.[8] Other treatments may include the use of dobutamine or in those with low blood volume, intravenous fluids.[1] Those with few symptoms and no worrisome features can often be closely followed.[2] The frequency of tamponade is unclear.[9] One estimate from the United States places it at 2 per 10,000 per year.[3]

  1. ^ a b c d e f g Spodick, DH (Aug 14, 2003). "Acute cardiac tamponade". The New England Journal of Medicine. 349 (7): 684–690. doi:10.1056/NEJMra022643. PMID 12917306.
  2. ^ a b c d e f g h i j k l m n Richardson, L (November 2014). "Cardiac tamponade". Journal of the American Academy of Physician Assistants. 27 (11): 50–51. doi:10.1097/01.jaa.0000455653.42543.8a. PMID 25343435. S2CID 205395461.
  3. ^ a b Kahan, Scott (2008). In a Page: Medicine. Lippincott Williams & Wilkins. p. 20. ISBN 9780781770354. Archived from the original on 2016-10-02.
  4. ^ "Tamponade | Meaning & Definition for UK English". Lexico.com. Archived from the original on March 4, 2021. Retrieved 2022-08-24.
  5. ^ a b "Cardiac Tamponade – Injuries and Poisoning". Merck Manuals Consumer Version. Retrieved 1 May 2020.
  6. ^ Schiavone, WA (February 2013). "Cardiac tamponade: 12 pearls in diagnosis and management". Cleveland Clinic Journal of Medicine. 80 (2): 109–116. doi:10.3949/ccjm.80a.12052. PMID 23376916.
  7. ^ Khandaker, MH; Espinosa, RE; Nishimura, RA; Sinak, LJ; Hayes, SN; Melduni, RM; Oh, JK (June 2010). "Pericardial disease: diagnosis and management". Mayo Clinic Proceedings. 85 (6): 572–593. doi:10.4065/mcp.2010.0046. PMC 2878263. PMID 20511488.
  8. ^ a b Sagristà-Sauleda, J; Mercé, AS; Soler-Soler, J (26 May 2011). "Diagnosis and management of pericardial effusion". World Journal of Cardiology. 3 (5): 135–143. doi:10.4330/wjc.v3.i5.135. PMC 3110902. PMID 21666814.
  9. ^ Bodson, L; Bouferrache, K; Vieillard-Baron, A (October 2011). "Cardiac tamponade". Current Opinion in Critical Care. 17 (5): 416–424. doi:10.1097/mcc.0b013e3283491f27. PMID 21716107. S2CID 25236604.