Potentially life-threatening emergency
Cardiac tamponade
Alerts and Notices
Synopsis
- Large bore intravenous (IV) access
- Point of care ultrasound assessment
- IV fluid administration
- Inotropic support
- Analgesia
- Pericardiocentesis
Cardiac tamponade is a true life-threatening medical emergency that is fortunately treatable with prompt diagnosis and treatment. Tamponade is a form of obstructive shock caused by elevated intrapericardial pressure that results in decreased cardiac filling and subsequent decreased cardiac output. Normally, the pericardium lacks compliance, and thus even a small increase in pericardial fluid can cause a rapid rise in pericardial pressure. If the pressure rises higher than the right-sided cardiac pressure, it causes decreased cardiac filling, ventricular interdependence, obstructive shock, and if untreated, cardiac arrest.
When intrapericardial pressure rises, it may yield in reduced cardiac filling secondary to changes in the right atrial-to-systemic venous pressure gradient. In severe cases, cardiac output is reduced to such an extent that the body is unable to maintain adequate systemic and coronary artery perfusion. Untreated, this leads to cardiovascular collapse and death.
All patients with pericardial effusions are at risk for tamponade. The causes of pericardial effusions are many and varied. They include, but are not limited to, trauma, malignancy, metabolic abnormalities (including uremia), pericarditis, tuberculosis, hypothyroidism, dissection, myocardial infarction, and iatrogenic injuries. Rapidly accumulating effusions pose a greater risk than do slower growing effusions.
The signs and symptoms of tamponade are nonspecific and are present in a variety of clinical scenarios. Primary symptoms of cardiac tamponade include dyspnea, chest pain, jugular venous distension, and tachycardia. Systemic blood pressure is often normal until severe tamponade is present due to compensatory changes of increased systemic vascular resistance. Tachypnea results from compensatory responses due to tissue hypoperfusions rather than as a primary pulmonary etiology. Other findings include cyanosis, peripheral leg edema, decreased heart sounds, fatigue, syncope, anuria, oliguria, pericardial friction rub, and pulsus paradoxus.
Rapidly accumulating pericardial effusions (eg, from trauma, iatrogenic causes, dissection) are more likely to present with symptoms similar to cardiogenic shock. These patients are likely hypotensive, tachycardic, and tachypneic, with cool extremities and other signs of poor perfusion. Slower growing effusions are more likely to present with shortness of breath, fatigue, relative hypotension, and edema.
Codes
ICD10CM:I31.4 – Cardiac tamponade
SNOMEDCT:
35304003 – Cardiac Tamponade
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Tension pneumothorax
- Right ventricular myocardial infarction
- Cor pulmonale
- Constrictive pericarditis
- Congestive heart failure
- Cardiogenic shock
- Septic shock
- Pulmonary embolism
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:08/27/2022
Last Updated:11/29/2022
Last Updated:11/29/2022
Potentially life-threatening emergency
Patient Information for Cardiac tamponade
Overview
Cardiac tamponade is a medical emergency in which blood or fluid fills the layer between the heart and the sac covering the heart (pericardium). This pressure prevents the heart from contracting properly and resulting in insufficient blood flow to the body.Who’s At Risk
Cardiac tamponade can occur from:- Tear in the aorta (dissecting aortic aneurysm)
- Lung cancer
- Heart attack, heart surgery, tumor, or medical procedures of the chest
- Radiation treatment
- Inflammation of the heart caused by viral or bacterial infections
- Injury to the heart
- Other heart, muscle, kidney, blood, thyroid, or autoimmune conditions
Signs & Symptoms
The symptoms of cardiac tamponade are:- Sharp chest pain which worsens with breathing and coughing
- Pain in neck, shoulder, abdomen, or back
- Difficulty breathing or rapid breathing
- Chest discomfort relieved by changing position
- Rapid heartbeat or palpitations
- Light headedness, fainting
- Anxiety, fatigue
- Blue-gray skin color
- Leg swelling due to fluid buildup
- Decrease in urine output
Self-Care Guidelines
Cardiac tamponade is often not preventable, despite a healthy lifestyle. Review the risk factors above and talk to your health care provider about your risk.You can improve your chances of survival and minimize damages by responding rapidly to signs of cardiac tamponade, a life-threatening medical emergency that will require emergency response.
When to Seek Medical Care
If symptoms develop, go to the hospital or call an emergency number immediately.Treatments
The fluid surrounding the heart must be drained as soon as possible:- Pericardiocentesis, or pericardial tap, is a procedure in which a needle is used to extract fluid from the tissue surrounding the heart
- Another procedure may involve cutting a part of the layer surrounding the heart (pericardium) to reduce pressure and extract the fluid
Fluids and oxygen may be given to reduce the workload required by the heart.
Blood pressure medication may be used to manage blood flow while fluid around the heart is drained.
Potentially life-threatening emergency
Cardiac tamponade