What are signs and symptoms of Acute Cardiac Tamponade?

The signs and symptoms of Acute Cardiac Tamponade include: - Chest pain: Similar to pericarditis, chest pain is a common symptom of cardiac tamponade. However, in the case of tamponade, the pain is often more severe. - Heart palpitations: Patients with tamponade may experience irregular or rapid heartbeats, also known as heart palpitations. - Shortness of breath: Difficulty breathing or feeling breathless, even with minimal exertion, is another symptom of tamponade. - Lightheadedness and fainting: In more severe cases, tamponade can lead to lightheadedness or fainting episodes. - Changes in mental state: Tamponade can affect brain function, leading to confusion, disorientation, or changes in mental state. - Cardiac arrest: In the worst scenarios, cardiac tamponade can cause the heart to stop beating, resulting in cardiac arrest. Physical signs that can help identify cardiac tamponade include: - Beck's triad: This includes low blood pressure, swollen neck veins, and muffled heart sounds. These signs indicate the presence of fluid around the heart. - Pulses paradoxus: This is a drop in systolic blood pressure by more than 10 mm Hg during deep breath. It is caused by fluid buildup around the heart and can be a sign of tamponade. It is important to note that diagnosing tamponade based solely on clinical signs can be challenging, as these signs are not always consistently present or specific.

What else can Acute Cardiac Tamponade be?

The other conditions that a doctor needs to rule out when diagnosing Acute Cardiac Tamponade are: - Pulmonary embolism (a blood clot in the lungs) - Myocardial infarction (a heart attack) - Type A aortic dissection (a severe condition where the large body artery rip, with the tear extending into the pericardium) - Tension pneumothorax (a severe type of collapsed lung)

What kinds of test are needed for Acute Cardiac Tamponade?

The types of tests needed for Acute Cardiac Tamponade include: - Bedside echocardiogram: This ultrasound test can show the size of the fluid buildup and signs of tamponade, such as the right side of the heart not filling correctly or the displacement of the heart's chamber wall. - Pericardiocentesis: This procedure involves inserting a needle through the chest wall into the sac around the heart to remove the fluid. It can be performed with or without imaging guidance. - Surgical drainage: If the fluid cannot be reached by a needle or if there are other complications, surgical drainage may be necessary. - Other tests, such as a computed tomography (CT) scan or a heart MRI, might also be done if myocarditis is suspected.

How is Acute Cardiac Tamponade treated?

Acute cardiac tamponade is treated with a procedure called pericardiocentesis. This involves inserting a needle through the chest wall into the sac around the heart to remove the fluid that has built up. The procedure can be done with or without imaging guidance, depending on the patient's condition. If the fluid cannot be reached by a needle or if there are other complications, surgical drainage may be necessary. To prevent further occurrences, a surgical procedure called a pericardial window can be performed to create a small hole in the pericardium and allow excess fluid to drain out, relieving pressure on the heart.

Acute Cardiac Tamponade

What is Acute Cardiac Tamponade?

The pericardium is a protective layer that surrounds the heart. This membrane consists of an outer layer, called the fibrous pericardium, and an inner double-layer, known as the serous pericardium. The space between these inner layers holds a small amount of fluid in a cavity, which is normal in healthy people. The pericardium’s primary function is to protect the heart and reduce friction when the heart beats.

Diseases related to the pericardium may include pericarditis, fluid buildup known as pericardial effusion, and a severe condition known as cardiac tamponade. Pericarditis is a common disease that happens when the pericardium gets inflamed. It’s one of the causes of chest pain that isn’t associated with a heart attack, and is reported in a small percentage of patients admitted to emergency departments for chest discomfort.

There are two types of pericarditis: non-constrictive and constrictive. Often, pericarditis comes with pericardial effusion, where excess fluid can accumulate in the cavity between the layers of the pericardium. In severe cases, this can lead to cardiac tamponade, a dangerous situation where too much fluid compresses the heart. This compression prevents the heart from filling with blood properly, leading to low blood pressure and could even result in heart failure.

This explanation sheds light on the causes, signs and symptoms, diagnosis methods, and treatment options for pericarditis and cardiac tamponade.

What Causes Acute Cardiac Tamponade?

Pericarditis, an inflammation of the pericardium around the heart, has no identifiable cause in about 90% of cases. Nevertheless, some known triggers include viral, bacterial, or tuberculosis infections. Other less common causes include tumors, disorders of the connective tissue, kidney failure, heart attacks (also referred to as Dressler syndrome), and heart surgery aftermath (commonly known as postpericardiotomy syndrome). Certain drugs, like procainamide and hydralazine, can also contribute.

Cardiac tamponade is a serious condition that can occur when fluid builds up in the pericardium. This fluid can be transudate (fluid pushed through the capillary due to high pressure), exudate (fluid that leaks around the cells of the capillaries), or blood. Gradual fluid build-up often happens due to tuberculosis or infections, autoimmune diseases, tumors, kidney issues, and various inflammatory diseases. The body tends to cope better with a slow accumulation than a rapid one. Rapid fluid build-up usually occurs in cases of severe bleeding due to a heart wound, heart wall rupture after a heart attack, or complications arising from a pacemaker implantation.

Risk Factors and Frequency for Acute Cardiac Tamponade

Acute pericarditis, a heart condition, is found in about 0.1% to 0.2% of patients hospitalized for chest pain not related to heart disease. Determining the number of pericardial effusions, where there is excess fluid around the heart, is challenging because many cases may not have noticeable symptoms. It’s estimated that there are about 2 cases per 10,000 people. This condition is more common in people with HIV, late-stage kidney disease, hidden cancers, tuberculosis, autoimmune diseases like lupus, or those who have had a severe chest injury.

Signs and Symptoms of Acute Cardiac Tamponade

Pericarditis is a condition that primarily involves sudden chest pain. This pain often gets better when you lean forward and increases when you lie down. Another similar condition, known as cardiac tamponade, exhibits more severe symptoms, including chest pain, heart palpitations, shortness of breath, and in worse scenarios, lightheadedness, fainting, changes in mental state, or even cardiac arrest.

Certain physical signs help identify cardiac tamponade. These are grouped under something called Beck’s triad, which includes low blood pressure, swollen neck veins, and muffled heart sounds. Another important sign is a drop in systolic blood pressure by more than 10 mm Hg during deep breath, known as Pulses paradoxus. This sign indicates a fluid buildup around the heart causing cardiac tamponade. The fluid pressure causes the wall between the two heart chambers to bend towards the left chamber during inhalation, further interrupting normal heart function and decreasing the amount of blood it pumps out. However, diagnosing tamponade based solely on clinical signs is difficult as they are not always consistently present or specific.

Testing for Acute Cardiac Tamponade

If a patient is thought to have pericarditis, which is inflammation of the tissue around the heart, doctors will start the evaluation with an electrocardiogram, often known as an ECG or EKG. It’s a test that checks the electrical activity of the heart. In some pericarditis patients, ECG can show specific changes that occur in four stages. The first stage involves a change in the ST-segment’s shape, the second stage shows the ST and PR segment returning to normal, and stages three and four show T-waves flipping upside down and then returning to normal.

Blood tests can also provide useful information when checking for pericarditis. For example, a full blood count could show an increased number of white blood cells, suggesting an infection. A basic metabolic profile test can show if a patient’s kidneys are not working well, a potential cause of pericarditis or fluid buildup around the heart. The presence of inflammation can be assessed by checking levels of the sedimentation rate and the C-reactive protein.

If pericarditis is confirmed or if there’s worry about a condition called cardiac tamponade – a serious problem where fluid builds up around the heart – a bedside echocardiogram may be done. This is an ultrasound test that can show how large the fluid buildup is and if there are signs of tamponade. Signs could include the right side of the heart not filling correctly or the wall that separates the heart’s chambers being pushed out of place. If myocarditis – an inflammation of the heart muscle – is suspected, a computed tomography (CT scan) or heart MRI might also be done.

Treatment Options for Acute Cardiac Tamponade

Acute pericarditis, or inflammation of the sac around the heart, can often improve by treating the underlying cause. The primary treatment involves taking high-dose non-steroidal anti-inflammatory drugs (NSAIDs), possibly combined with a medication called colchicine, over several weeks. For a specific type of pericarditis called Dressler syndrome, which can happen after a heart attack, high-dose aspirin is used. Doctors usually consider the treatment effective if the patient reports relief from symptoms.

Doctors generally do not recommend corticosteroids, a type of anti-inflammatory medication, as the first option because they can increase the chance of pericarditis coming back. But for patients taking corticosteroids due to recurring pericarditis, doctors may consider other immunosuppressive medications such as azathioprine or intravenous immunoglobulin.

Cardiac tamponade, a serious condition where fluid builds up around the heart, is treated with a procedure called pericardiocentesis. In this procedure, a needle is inserted through the chest wall into the sac around the heart to remove the fluid. The procedure can be performed with or without imaging guidance depending on the patient’s condition. If the heart can’t be reached by a needle, there’s clotted blood in the pericardium, bleeding within the pericardium, or other chest conditions that make needle drainage difficult or ineffective, surgical drainage may be necessary.

To prevent further occurrence, a surgical procedure known as a pericardial window can be performed by a heart and chest surgeon. This procedure helps release the pressure on the heart by creating a small hole in the pericardium to allow excess fluid to drain out.

When trying to diagnose cardiac tamponade, a condition where fluid builds up in the heart, doctors would typically want to rule out other possible conditions that could cause similar symptoms.

These might include:

Pulmonary embolism (a blood clot in the lungs)
Myocardial infarction (a heart attack)
Type A aortic dissection (a severe condition where the large body artery rip, with the tear extending into the pericardium)
Tension pneumothorax (a severe type of collapsed lung)

Additionally, while assessing for pericarditis (inflammation of the heart’s outer layer), doctors would also ponder other conditions causing chest pain, such as: