Cardiac Tamponade; Symptoms, Diagnosis, And Treatments

The Heart is the heart of your survival. Just about the size of a fist, this muscular organ does many functions to keep you alive! The heart pumps blood to the whole body through a network of arteries and veins, so that the body gets enough oxygen. The heart acts as a coordinated machine while pumping blood. The right side of the heart pumps blood to the lungs, while the left side pumps it back to the body. Every cell in the body except the corneas gets blood from the heart. It functions tirelessly to keep you alive. Every minute, it pumps 1.5 gallons of blood all over the body.

Cardiac Tamponade; Symptoms, Diagnosis, And Treatments

However, there can be situations where the heart goes helpless, encountering sudden breakdowns. You might be familiar with names like cardiac arrest, heart block, and heart failure. Some several conditions and diseases can damage heart health. Cardiac Tamponade or Pericardial Tamponade is one among them, though it is rare.

Cardiac Tamponade is a severe medical emergency that can be fatal if not addressed promptly. It occurs when the heart muscles get loaded with excessive pressure due to the build-up of fluid. The pericardium is the sac that surrounds the heart and the great vessel roots. A small amount of fluid in this area helps prevent friction between the layers of tissues. It gets worse when the fluid amount is higher than the normal and results in too much pressure on the heart. It can finally affect the heart’s ability to pump blood all over the body properly.

The condition can be alarming if the fluid builds up too fast. Cardiac Tamponade is a medical emergency, which needs to be addressed immediately. Knowing Cardiac Tamponade symptoms can only help you identify the condition quickly. Here in this article, we are discussing the symptoms of Cardiac Tamponade, the causes, and treatments.

Cardiac Tamponade Explained:

The pericardium is the thin, double-walled sac around the heart. This fibrous sac is made upon two thin layers. It is normal to have a small amount of fluid between these two layers. The fluid helps in preventing any friction between the layers that may occur when they move while the heartbeats.

Sometimes, extra fluid may accumulate abnormally between the two layers. Penetration of pericardium results in cardiac tamponade. Excess blood or other fluids accumulated in this area can compress the heart. As a result, the heart may find it difficult to expand normally. The amount of blood entering the heart may get decreased as the excess fluid presses the heart.

As a result, less oxygen-rich blood can get pumped into the rest of the body. This can eventually result in shock, organ failure, or even death! It is called acute cardiac tamponade when the fluid builds up too quickly. Acute cardiac tamponade can be life-threatening if not treated immediately. Subacute cardiac tamponade is when the fluid builds up slowly.

Knowing the Signs and Symptoms:

Chest pain and lightheadedness are the main signs as the condition damages the ability to circulate blood throughout the body. But these can be the signs of other conditions as well. The three typical signs, known as Beck’s triad, are:

• Dull heart sound
• Low blood pressure in the arteries
• Bulging neck veins

These signs may occur along with the following symptoms:

• Colder and bluish skin
• A weak pulse
• Rapid heart rate
• Lightheadedness
• Drowsiness
• Anxiety
• Shortness of breath
• Fainting
• Stabbing pain in the chest, abdomen, shoulder or back
• Panting

Severe cardiac tamponade sometimes causes very low blood pressure. It can also cause symptoms of shock such as pale skin, cool arms, legs, fingers, and toes. Some of the symptoms of cardiac tamponade might look like other health problems. If you see any of these or a combination of these symptoms in you or someone you know, seek immediate medical attention for better diagnosis.

Causes of Cardiac Tamponade:

Fluid build-up between the layers of the pericardium is the root cause of Cardiac Tamponade. The condition is classified as acute and subacute, based on the quickness of fluid build-up. Acute cardiac tamponade is when fluid build-up occurs rapidly. Subacute condition is when the build-up is slower. There can be several things that can contribute to developing the condition. Some of the most common are, as listed:

• Heart attack
• Deep chest injury
• Inflammation of the pericardium
• Bacterial infection
• Kidney failure
• Hypothyroidism
• An autoimmune condition called lupus
• Tuberculosis
• Cancer
• A bulge in the aorta, or bursting of aortic aneurysm
• Complications from heart surgery

Diagnosis; steps to find it right

The first step of diagnosis is checking for Beck’s triads as they are the classic symptoms of Cardiac Tamponade. Checking the blood pressure, examining the veins, and listening to the heartbeat helps understand the medical signs. Additional tests may be carried out to support the diagnosis.

• Echocardiogram: Cardiac Tamponade suspects will be advised to undergo echocardiogram tests to get a detailed image of their heart. The ultrasound test helps find if there is fluid accumulation in the pericardium. The procedure uses sound waves and produces the image of a patient’s heart. It allows the doctor to see the heart beating and pumping the blood. The procedure records images of the sound-waves echoes. Ultrasound recording of the blood flow helps the doctor understand if there is any block or pause.
• Chest X-ray: Chest x-rays can be done to find if the heart is abnormally large or misshapen due to the fluid build-up. Patients with cardiac tamponade will have an enlarged cardiac silhouette.
• Electrocardiogram or ECG: ECG helps the doctor analyze the electrical activity of the heart. It records the electrical signals in your heart. ECG is one of the most preferred diagnostic tools for cardiac tamponade.
• Computerized Tomography (CT) scan: CT scan helps find the extra fluid accumulation in the pericardium.
• Magnetic Resonance Angiogram (MRA): The test can find abnormalities in the blood flow through the heart’s blood vessels if any.

Blood tests to find the red and white blood cell levels may also be suggested for detailed diagnosis. It might also help detect certain enzymes the body releases when the heart muscle is damaged. Other tests may also be suggested to find out the cause:

• Blood tests that can spot infections, if any
• Blood tests to find if affected by autoimmune diseases
• Analysis of the excess fluid to rule out infection or cancer
• Blood tests to find metabolic problems, if any

How common is Cardiac Tamponade?

The condition is very rare and can affect anyone. Those with other medical conditions are at more risk of getting affected. People with a history of HIV, heart failure, tuberculosis, end-stage renal disease, and malignant tumors are at a higher risk when compared to the general population.

Treatments:

Cardiac Tamponade symptoms need to be addressed promptly as it can lead to shock or even death. Treatments aim at draining out the excess fluid from the pericardial sac. It may vary from simple procedures to complex surgeries according to the severity. To remove the fluid and reduce the pressure of the heart, the doctor may choose:

• Pericardiocentesis: In this procedure, the doctor removes the fluid out of the pericardium using a needle.
• Pericardiectomy: A part of the pericardium will get removed to reduce the pressure on the heart.
• Thoracotomy: It is a surgical procedure by which the excess fluid is removed through an incision in the chest.

Pericardiocentesis is the first option of a minimally invasive procedure to treat cardiac tamponade. Doctors mostly choose it as the procedure has lesser significant complications and mortality rates. A thin tubed called catheter and a needle are used to remove the fluid. In some cases, the surgeons may drain the pericardial sac. The surgeon may also remove some of the pericardium, which will help rule out the cause of cardiac tamponade. It also prevents recurrent fluid build-up. The procedure of removing some part of pericardium is called a pericardial window.

Severe cases may require thoracotomy surgery. Cardiac tamponade symptoms might improve once the fluid is removed. Once the excess fluid is removed, the doctor may investigate further to find the underlying cause and instruct further treatments. The final results of treatments may vary depending on the cause of the fluid build-up, case severity, treatment speed, and other conditions that the patient undergoes.

In addition to fluid removal, other treatments and therapies might also require:

• Therapy to reduce the cause of fluid accumulation. If caused by a bacterial infection, it can be antibiotic therapy.
• Regular monitoring with the help of echocardiogram
• Medications or fluids to improve the blood pressure
• Pain medicine, if the patient experiences pain
• Anti-inflammatory medicines
• Medications to help stronger heartbeat
• Might require blood transfusions, if the build-up is caused by trauma or open surgery

Possible complications of the condition:

In most cases, cardiac tamponade may not cause many complications if treated on time. If left untreated, it can lead to shock. Shock can further lead to serious other complications like organ failure.

What can you do to prevent cardiac tamponade?

Heart health is the heart of health, and heart diseases are the greatest threats one must consider. One of the most important keys to heart health is regular exercise. You can control your heart health through regular exercise, diet, and reducing stress. You can lower the risk for cardiac tamponade to an extent, by managing your heart health. However, many cases cannot be prevented.

When should you seek medical help?

Don’t hesitate to reach the emergency dial, if you are experiencing the symptoms of cardiac tamponade. Chest pain, breathing problems, or symptoms of shock can be the indicators. Get help from someone to reach the hospital immediately.

Key points:

• Extra fluid accumulation in the pericardial space causes cardiac tamponade
• The pressure on the heart pushes it back from pumping the blood properly all over the body
• Cardiac tamponade is a medical emergency
• If left untreated, the condition can lead to shock and death!
• Most cases need to get the extra fluid removed
• Less severe cases might not require a surgery