Definition

Cardiac tamponade is when fluid builds up in the sac around the heart. The fluid puts pressure on the heart. The pressure reduces the amount of blood that is pumped in and out of the heart.

This condition can be life-threatening. It can be treated, but it can return after treatment.

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Causes

Cardiac tamponade can be caused by many things, such as:

• An infection that causes pericarditis —an inflammation of the sac around the heart
• Bleeding into the heart sac, caused by injury
• A ruptured heart muscle
• Cancer in or near the heart

Risk Factors

Things that raise the risk of cardiac tamponade are:

• Heart surgery, or injury to the heart
• Tumors in the heart
• Heart attack or congestive heart failure
• Lung cancer
• Kidney failure
• Radiation therapy to the chest
• Hypothyroidism
• Certain diseases that cause inflammation, such as: systemic lupus erythematosus, rheumatoid arthritis, Behcet disease, sarcoidosis, scleroderma, and systemic vasculitis

Symptoms

Symptoms vary from mild to severe. They may include:

• Tiredness or sleepiness
• Fast breathing or problems breathing
• Lightheadedness, weakness, or fainting
• Chest pain
• Cough, problems swallowing, hoarseness, or hiccups
• Swelling of the belly, veins in the arms or legs, or other areas
• Fast heartbeat
• Nausea or lack of hunger

Diagnosis

The doctor will ask about symptoms and health history. A physical exam will be done.

• Imaging tests will be done to check the heart and surrounding structures. They may include:
  • Chest x-ray
  • Echocardiogram
  • CT scan
  • MRI scan
  • Coronary angiography
• The doctor may need to test heart activity with:
  • Cardiac catheterization
  • ECG

Diagnosis is usually based on symptoms and confirmed with testing.

Treatment

Cardiac tamponade is a serious condition. It needs to be treated right away in the hospital.

The goal of treatment is to:

• Ease symptoms
• Improve heart function
• Treat underlying conditions
• Save the person's life

Treatments include:

• Pericardiocentesis —a procedure to drain the fluid around the heart
• Fluids to maintain normal blood pressure
• Medicines to:
  • Fight infection
  • Ease inflammation and pain
  • Improve blood pressure and heart function
• Oxygen to reduce workload on the heart

Sometimes there are problems—or not enough fluid can be drained. If so, surgery may be done to remove or cut part of the pericardium.

Prevention

There are no current guidelines to prevent cardiac tamponade.