Malignant Pericardial Effusion

Cardiac Tamponade

Cardiovascular

Written by the doctors and editors at UpToDate
What is cardiac tamponade? — Cardiac tamponade is a condition in which extra fluid builds up around the heart and presses on it. The pressure builds up in a sac called the "pericardium" that is around the heart (figure 1). The pressure can be mild or severe. Cardiac tamponade can happen after a heart attack or heart or lung surgery. It can also be related to an infection, cancer that has spread, or injury to the chest.
Cardiac tamponade keeps the heart from getting enough blood back from the rest of the body. If the heart does not get enough blood back, it cannot pump as much out to the body again. If the heart is not pumping right, this can cause serious health problems. Cardiac tamponade that happens suddenly, such as from an accident, can be very serious. It can even cause death.
What are the symptoms of cardiac tamponade? — The symptoms are different depending on whether cardiac tamponade happens suddenly or slowly.
If cardiac tamponade happens suddenly, symptoms can include:
Chest pain
Shortness of breath, fast breathing, or both
If cardiac tamponade happens slowly, symptoms can include:
Tiredness
Shortness of breath
Chest pain or discomfort, such as feeling like the chest is heavy or full
Fainting, or feeling faint
Swelling in the lower legs
Will I need tests? — Yes. The doctor can often tell if you have cardiac tamponade based on the symptoms. But if he or she thinks you have it, you will probably have the following tests:
An electrocardiogram (ECG) – This test measures the electrical activity in your heart (figure 2). It can show an abnormal heartbeat. Most people with cardiac tamponade have a fast heartbeat.
A chest X-ray – A chest X-ray can show if the heart is larger than it should be. This can happen if cardiac tamponade happens slowly.
An echocardiogram – This test uses sound waves to create a picture of your heart as it beats (figure 3). It shows the different parts of the heart and how well it is working. If you have fluid around your heart, this test can show the doctor if the fluid could cause cardiac tamponade.
How is cardiac tamponade treated? — Cardiac tamponade is usually treated by draining the extra fluid from the sac around the heart. This relieves the pressure on the heart and lets it do a better job pumping.
To drain the fluid, doctors can use a needle and thin tube, or do surgery. If cardiac tamponade happens suddenly, the doctor might do surgery right away.
After the doctor drains the fluid, he or she will usually order another echocardiogram. This test shows if enough fluid was drained. It can also show if the fluid comes back.
A few people with mild cardiac tamponade do not have fluid drained right away. In these people, the fluid is not causing heart or blood flow problems. Or the extra fluid only causes mild changes in how the heart works. In these cases, doctors do regular exams and tests to check how well the heart is working. If another condition is making extra fluid build-up, the doctor or nurse will treat that condition.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 82942 Version 5.0
Release: 28.2.2 - C28.105
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Acute Pericardial Tamponade,Low-Pressure Tamponade,Regional Tamponade,Subacute Pericardial Tamponade

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