Cardiac Tamponade

Cardiac tamponade is a medical emergency that occurs when blood or a bodily fluid fills thespace 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, the heart pumps a decreased amount of blood to the rest of the body causing possible organ failure, shock,and death. There are a plethora of 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 an MVA, a fight, or a work related injury, an accidental perforation after acardiac catheterization, angiography, or pacemaker insertion, or a puncture during central line placement.

A person who is the victim of any of these situations will show signs of increased anxiety, restlessness, low blood pressure, weakness, chest pain that radiates up their neck and shoulders, back pain, difficulty breathing (deep breathes), rapid breathing, fainting, dizziness, and discomfort relieved by sitting and leaning forward. The victim’s skin will appear pale, gray, or blue in color; there may be 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, please call 911 immediately or drive the victim to the nearest ER ASAP!

A cardiac work-up, performed at the ER,will include an echocardiogram to diagnose the problem, a cardiac ultrasound to assess the distention of the pericardium to see if the ventricles have collapsed due to the low blood volume, a chest X-ray to determine the possibility of an enlarged heartand fractures, an EKG to assess heart rhythms, a magnetic resonance angiogram (MRA) to assess blood flow to the heart, and a 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. 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, apericardiectomy, 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 and call 911 withouthesitation. Prognosis is often good if treated quickly; unfortunately, death will result if fluid or blood is not removed from the sac quickly.