Cardiac Tamponade: Symptoms, Causes, Treatment, and Prevention

Medically Reviewed By Dr. Payal Kohli, M.D., FACC
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Cardiac tamponade is the chest pain and discomfort that occurs when the heart does not receive enough blood. This happens due to excess pressure around the heart muscle. This means that the heart is not able to pump enough oxygenated blood, and therefore neither is the rest of your body. A buildup of fluid in the sac that surrounds the heart, known as the pericardium, causes cardiac tamponade. This fluid buildup is called pericardial effusion. Symptoms either develop quickly and severely, called acute, or over a longer period of time, called subacute. Both forms require immediate medical attention. If symptoms develop quickly, it can be a life threatening emergency.

The incidence of cardiac tamponade in the overall population is rare, with approximately 5 in every 10,000 people in the United States receiving a diagnosis.

Treatment may include lifestyle changes, medications, monitoring, and surgical procedures.

This article looks at cardiac tamponade and its symptoms, causes, and treatments. Read on to learn how to lower your risk of some of the health problems that can lead to cardiac tamponade.

What is cardiac tamponade?

there is a model of a human heart
Meindert van der Haven/Getty Images

Cardiac tamponade is a medical emergency.

Cardiac tamponade occurs when fluid builds up in the space that surrounds your heart. This increase in fluid places pressure on your heart, preventing it from pumping efficiently. The surrounding pressure increases, which prevents the heart from expanding. It does not receive enough oxygen-rich blood, so it cannot pump to the rest of the body.

Lack of oxygen-rich blood in the heart and the body can lead to further complications. These include shock, cardiac arrest, and organ failure.

If you experience any symptoms of cardiac tamponade, you should immediately seek medical attention.

Cardiac tamponade vs. pericardial effusion

The space that surrounds the heart is known as the pericardium. This is a sac made up of two thin layers. In an unaffected heart, a small amount of fluid is present to prevent friction when your heart beats. The fluid protects the heart from damage in a similar way that bubble wrap protects fragile items. In a person with cardiac tamponade, there is too much fluid.

This buildup of excess fluid in the pericardium is known as pericardial effusion. When this fluid buildup causes high levels of pressure on your heart, it is called cardiac tamponade.

What can cause cardiac tamponade?

Cardiac tamponade can happen for many different reasons. The most common cause is inflammation of the pericardium, known as pericarditis. It can also occur if you have suffered trauma to the chest area that has penetrated the pericardium.

Other causes include, but are not limited to:

  • Bacterial infections: Infections of the bloodstream, such as septicemia, can cause the pericardium to become enlarged in response to a bacterial infection. This can cause increased pressure on your heart. Tuberculosis can also cause effusion.
  • Immune conditions: If you have a preexisting autoimmune condition, such as lupus or arthritis, you may have an increased risk of developing a cardiac disorder, such as cardiac tamponade.
  • Trauma: Stab wounds, injuries from a car accident, or other trauma to the chest can cause harm to the pericardium.
  • Medical treatment: Therapies such as radiotherapy and chemotherapy can place your heart under stress. This can increase your risk of cardiac tamponade. Some medications can increase your risk of developing cardiac tamponade. These include the seizure medication phenytoin and the blood pressure medication minoxidil.
  • Cancer: Cancer itself, not just its treatments, can also affect the pericardium.
  • Surgery: Surgery involving the chest region can increase your risk of cardiac tamponade. Examples include surgery for lung cancer or surgery involving the heart valves.

What are the signs and symptoms of cardiac tamponade?

Cardiac tamponade limits the ability of the heart to sufficiently circulate oxygenated blood.

Beck’s triad

There are three key signs of cardiac tamponade. Medical professionals commonly refer to these symptoms as Beck’s triad:

  • low blood pressure in the arteries on the left side of your body
  • muffled heart sounds
  • swollen neck veins

Learn more about jugular vein distention, or swollen veins in the neck, here.

Other symptoms

Reduced blood flow and oxygen to the heart and body can cause a variety of other symptoms. It is important to look out for these. These can include, but are not limited to:

  • fast heart rate
  • fatigue
  • dizziness
  • pain in the chest, shoulder, back, or abdomen, known as radiating pain
  • weak pulse
  • swelling in the arms and legs
  • shortness of breath
  • low blood pressure and narrow pulse pressure, which is the difference between top and bottom blood pressure numbers

Symptoms of cardiac tamponade can feel similar to those of other health conditions. If you experience any of these symptoms, please contact a healthcare professional for advice.

How do doctors diagnose cardiac tamponade?

If you contact a healthcare professional with concerns about cardiac tamponade, they will ask about your past health. You will also undergo a physical exam to eliminate other causes of your symptoms. In particular, they will look for a significant drop in your blood pressure when you take a breath.

During the exam, you may undergo some of these tests:

  • Chest X-ray: This helps to visualize your heart and any abnormalities, such as an enlarged heart.
  • Electrocardiogram (ECG): This looks for any variation in your heart’s electrical rhythms.
  • Echocardiogram: This can show the amount of fluid around your heart and its motion while pumping.
  • Scans: MRI scans and CT scans show the structure of your heart.

Diagnosing the cause

After diagnosing cardiac tamponade, it is important for your healthcare professional to find the cause. Different causes of cardiac tamponade can require different treatment plans, such as if you are experiencing shock.

To find the cause of cardiac tamponade, you may need some of the following tests:

  • blood tests to look for any infections or autoimmune conditions
  • analysis of fluid from the space around the heart

What are the treatment options for cardiac tamponade?

It is very likely a person with cardiac tamponade will require hospitalization.

Some procedures doctors may recommend include:

  • Pericardiocentesis: In this procedure, clinicians drain excess fluid from the pericardial sac without open-heart surgery. It is one of the most common treatments for cardiac tamponade. Techniques have advanced over the years, greatly improving its safety and effectiveness.
  • Pericardioperitoneal and pericardiopleural windows: This is a surgical creation of a window in the pericardial sac that surrounds your heart. It will allow some of the fluid to drain. This will relieve pressure on the heart, allowing it to receive enough blood to reduce your symptoms.

Some of the therapeutic treatments you may be given in addition to procedures include:

  • therapies to target the cause of the fluid buildup, such as antibiotics for a bacterial infection
  • consistent and careful monitoring of your heart with echocardiograms
  • medications to increase your blood pressure
  • anti-inflammatory and pain medications, such as aspirin
  • possible blood transfusion, if the buildup of fluid is due to a trauma event or surgery
  • IV fluids to keep your blood pressure up

Tell your doctor if you are having side effects from your medications. Your doctor can likely find an alternative medication that may work better for you.

What are the possible complications of cardiac tamponade?

If cardiac tamponade is treated promptly, complications can be averted.

However, if left untreated, there can be serious complications, such as shock.

Shock can reduce blood flow in the body, leading to more serious conditions such as organ failure.

View our hub on heart health here.

When to contact a doctor

If you or someone you are with has symptoms of cardiac tamponade, seek medical care immediately.

If you are experiencing shortness of breath, chest pain, or any symptoms of shock, contact the emergency services.

Summary

Cardiac tamponade happens because of a buildup of fluid in the pericardium. It is a medical emergency. People with cardiac tamponade may present with Beck’s triad, which comprises low blood pressure, muffled heart sounds, and swollen veins in the neck.

Cardiac tamponade can happen following a number of conditions or events, including pericarditis, infection, or trauma to the chest. Treatment will involve managing the underlying cause and allowing the excess fluid to drain.

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Medical Reviewer: Dr. Payal Kohli, M.D., FACC
Last Review Date: 2022 Jun 28
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