Cardiac tamponade

Cardiac tamponade
Other names	Pericardial tamponade
A very large pericardial effusion resulting in tamponade as a result of bleeding from cancer as seen on ultrasound. Closed arrow – the heart; open arrow – the effusion
Specialty	Cardiac surgery
Symptoms	Shortness of breath, weakness, lightheadedness, cough[1]
Usual onset	Rapid or more gradual[2]
Causes	Cancer, kidney failure, chest trauma, pericarditis, tuberculosis[2][1]
Diagnostic method	Symptoms and ultrasound of the heart[2]
Treatment	Drainage (pericardiocentesis, pericardial window, pericardiectomy)[2]
Frequency	2 per 10,000 per year (US)[3]

Cardiac tamponade, also known as pericardial tamponade (/ˌtæm.pəˈneɪd/^[4]), is a compression of the heart due to pericardial effusion (the build-up of pericardial fluid in the sac around the heart).^[2] Onset may be rapid or gradual.^[2] Symptoms typically include those of obstructive shock including shortness of breath, weakness, lightheadedness, and cough.^[1] Other symptoms may relate to the underlying cause.^[1]

Common causes of cardiac tamponade include cancer, kidney failure, chest trauma, myocardial infarction, and pericarditis.^[2][5] Other causes include connective tissues diseases, hypothyroidism, aortic rupture, autoimmune disease, and complications of cardiac surgery.^[2][6] In Africa, tuberculosis is a relatively common cause.^[1]

Diagnosis may be suspected based on low blood pressure, jugular venous distension, or quiet heart sounds (together known as Beck's triad).^[2][1][7] A pericardial rub may be present in cases due to inflammation.^[2] The diagnosis may be further supported by specific electrocardiogram (ECG) changes, chest X-ray, or an ultrasound of the heart.^[2] If fluid increases slowly the pericardial sac can expand to contain more than 2 liters; however, if the increase is rapid, as little as 200 mL can result in tamponade.^[2]

Tamponade is a medical emergency.^[5] When it results in symptoms, drainage is necessary.^[8] This can be done by pericardiocentesis, surgery to create a pericardial window, or a pericardiectomy.^[2] Drainage may also be necessary to rule out infection or cancer.^[8] Other treatments may include the use of dobutamine or in those with low blood volume, intravenous fluids.^[1] Those with few symptoms and no worrisome features can often be closely followed.^[2] The frequency of tamponade is unclear.^[9] One estimate from the United States places it at 2 per 10,000 per year.^[3]