Cardiac (Pericardial) Tamponade

Cardiac (Pericardial) Tamponade – Growing up, I had a very cool aunt by the name of Mary. She drove a royal blue SS Chevy Nova with racing tires and two wide white stripes that stretched from the hood of the car to its trunk. As I write this article, I can still hear the roaring sound of the engine. She never drove fast, but the car fit her image: a young, hip, smoker, and social drinker.

Over the years, Aunt Mary accumulated multiple health issues. One incident in particular occurred that frightened me the most because I thought Aunt Mary was going to die. One evening, she gradually became weak, was having difficulty breathing, and could only walk short distances. Her condition became worse when she tried lying flat on her back. She was immediately rushed to the hospital in an ambulance. A few days later, I learned that a doctor saved her life by performing a pericardiocentesis, a procedure that uses a needle to remove fluid from the sac that surrounds the heart.

Years later, as a nursing student, I began to understand Aunt Mary’s health history. She was diagnosed with cardiac tamponade.

What is cardiac tamponade?

● Cardiac tamponade is a medical emergency that occurs when the blood or a bodily fluid fills the space between the heart and the pericardium (the sac that surrounds the heart).
● The filling of the space puts pressure on the heart, thus making it difficult for the ventricles to contract properly.
● The result of the heart pumping a decreased amount of blood to the rest of the body may lead to organ failure, shock, and possibly death.

Causes

There are many causes of cardiac tamponade; however, for the sake of this blog, I will focus on personal injuries.

● Cardiac tamponade can be caused by gunshot or stab wounds
● Blunt force trauma to the chest from a motor vehicle accident
● A fight
● A work-related injury
● An accidental perforation after a cardiac catheterization, angiography, or pacemaker insertion; or a puncture during central line placement

Symptoms

● People who are victims of any of these causes will show signs of increased anxiety,
● Restlessness
● Low blood pressure
● Weakness
● Chest pain that radiates up the neck and shoulders
● Back pain
● Difficulty breathing (deep breathes)
● Rapid breathing
● Fainting
● Dizziness
● Discomfort relieved by sitting and leaning forward
● Their skin will appear pale, gray, or blue in color
● They may have swelling in the legs and abdomen
● A weak pulse, or bulging veins because blood is having a difficult time traveling back to the heart

If anyone exhibits any of these symptoms, call 911 immediately or drive the victim to the nearest emergency room ASAP!

Treatment

A cardiac work-up will be performed upon arrival at the ER and will include the following:

● Echocardiogram (Cardiac ultrasound) to diagnose the problem and to assess the distention of the pericardium to see if the ventricles have collapsed because of the low blood volume
● Chest X-ray to determine the possibility of an enlarged heart and fractures
● EKG to assess heart rhythms
● Magnetic resonance angiogram (MRA) to assess blood flow to the heart
● Right heart catheterization to assess vascular blockages.

❖ Treatment will depend on the results of the tests; moreover, physicians and surgeons will treat the underlying causes.
❖ Intravenous (IV) fluids and medication will be administered to keep blood pressure regulated until fluid is drained from the heart.
❖ Oxygen will be administered to help reduce overworking the heart and reduce tissue damage caused by low blood flow.
❖ If there is fluid surrounding the heart, a pericardiocentesis (a procedure using a needle to remove fluid from the pericardial sac) will be performed ASAP to drain it. If necessary, a pericardiectomy, a surgical procedure to remove a portion of the pericardium (pericardial window) to relieve pressure, may be required.

It is important to recognize the signs and symptoms of cardiac tamponade. Call 911 without hesitation. Prognosis is often good if treated quickly; unfortunately, death will result if fluid or blood is not removed from the sac.