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Heart Consult

What is Pericardial Tamponade?

Human heart has three layers, the outer one being pericardium. Pericardial sac is made of two thin layers of tissue that enclose our heart. Between the two layers is a small amount of fluid. This fluid keeps the layers from rubbing against each other and causing friction.

Cardiac tamponade or pericardial tamponade is a life threatening situation, where fluid (mostly blood) accumulates in the space between the pericardial sacs, faster than the pericardial sac can stretch. The outer pericardium is made of fibrous tissue which does not easily stretch, and so once fluid begins to enter the pericardial space, pressure starts to increase. This causes increase in pressure on the heart, thus preventing the proper filling of heart. The French verb "tamponner" means to plug up and, also, to smash into. Here the accumulating fluid within the pericardial sac is, so to speak, smashes into the heart. The end result, if untreated, is low blood pressure, shock and death.

  • Pericarditis
  • Physical trauma (penetrating injury or blunt trauma)
  • Hypothyroidism (a condition of under functioning of thyroid glands)
  • Iatrogenic (invasive procedure induced)
  • Myocardial rupture
  • Cancer
  • Cardiac surgery

Pericardial Tamponade Signs

Tamponade may present with symptoms of rapid breathing, difficulty in breathing, anxiety, restlessness, fainting, chest pain, palpitations. On examinations the blood pressure will be low, with decreased heart sounds.

Pericardial Tamponade

Pericardial Tamponade

Diagnosis

Diagnosis of Tamponade can often be challenging. It can be diagnosed radiographically, if time allows. Echocardiography often demonstrates an enlarged pericardium, and a chest x-ray of a large cardiac tamponade will show a large, globular heart. The clinical acumen of the consultant plays a bigger part than imaging.

Treatment

Management of tamponade involves both prehospital and hospital care. When the cardiac output is being compromised, the peripheral tissues are being starved for oxygen. As a first aid measure, oxygen can be administered. Prompt diagnosis and treatment is the key to survival with tamponade. In advanced settings, prehospital teams perform pericardocentesis, which can be life saving.

The hospital management involves Pericardiocentesis. This involves the insertion of a needle through the skin and into the pericardium and through the chest wall, and aspirating fluid. Often, a cannula is left in place during resuscitation, following initial drainage so that the procedure can be performed again if the need arises. The other procedure being to create a Pericardial window. Following stabilization of the patient, surgery is provided to permanently mend the source of the bleed and repair the pericardium.