Cardiac Tamponade

What is cardiac tamponade?

Cardiac tamponade happens when the fluid sac around your heart fills with too much blood or other fluid and puts pressure on your heart. This prevents your heart’s chambers from filling properly.

When your heart can’t fill with blood properly, it can’t pump as much and your blood pressure drops. Your heart may beat faster (more than 100 beats per minute) to try to pump more blood.

Cancer, infections, trauma and certain diseases can cause cardiac tamponade. Without treatment, it’s life-threatening.

What happens in cardiac tamponade?

Inside your chest, a sac called the pericardium surrounds your heart. The pericardium has two layers and pericardial fluid that holds your heart in place.

Cardiac tamponade — or pericardial tamponade — happens when the pericardium fills with fluid (usually pericardial fluid or blood). Because the fluid has nowhere to go, your heart runs out of room and can’t expand enough to fill effectively.

How cardiac tamponade relates to pericardial effusion

Pericardial effusion is the technical term for when the pericardium is filling up with fluid. Effusions can consist of blood, discharge and other blood component products. A pericardial effusion doesn’t always cause cardiac tamponade, especially when the fluid builds up slowly over time. This is because it has time to stretch and make more room for fluid, and the process may not cause symptoms. Cardiac tamponade is when pressure from surrounding fluid keeps your heart from beating properly.

How common is cardiac tamponade?

This condition can happen to people of all ages. About 2 out of every 10,000 people get cardiac tamponade from other diseases.

What are the symptoms?

When this condition happens quickly, cardiac tamponade symptoms may include:

• Sharp pain in the chest. The pain may also radiate or extend to nearby parts of your body like your arm, back, neck or shoulder. It may also get worse when you breathe deeply, lie flat or cough.
• Trouble breathing or breathing rapidly.
• Fainting, dizziness or lightheadedness.
• Changes in skin color, especially pale, gray or blue-tinted skin.
• Heart palpitations (where you become unpleasantly aware of your heartbeat).
• Fast pulse.
• Altered mental status. A person with cardiac tamponade won’t act like themselves and may act confused or agitated.

When the condition happens more slowly, you may also have these cardiac tamponade symptoms:

• Shortness of breath.
• Swelling in your abdomen or legs.
• Fatigue or tiredness.
• Chest discomfort that typically gets better when you lean forward or sit up.

What causes cardiac tamponade?

Cardiac tamponade causes include:

• Blunt trauma, such as a fall or a car crash.
• Penetrating trauma, like a stab wound from a knife.
• Aortic dissection.
• Advanced cancer.
• Heart attack.
• Tuberculosis (TB).
• Inflammation or infection of the pericardium.
• Chronic immune diseases like lupus, rheumatoid arthritis and scleroderma.
• Heart cancer.
• Heart or kidney failure.
• Hypothyroidism.

In some cases, cardiac tamponade can also happen after a medical procedure. Some of these include:

• Surgery on your heart or near the pericardium.
• Catheter-based procedures that involve your heart or surrounding blood vessels.
• Placement of a device like a pacemaker.
• Radiation therapy near your heart or pericardium.

Who is at risk for cardiac tamponade?

Fluid is more likely to build up in your pericardium if you have:

• Congestive heart failure.
• Heart surgery or catheter-based procedures.
• HIV.
• End-stage kidney disease.
• Autoimmune diseases.
• Cancer.
• Tuberculosis.

What are the complications of cardiac tamponade?

Cardiac tamponade complications can include:

• Cardiogenic shock.
• Heart failure.
• Death.

Cardiac tamponade is dangerous because it ultimately limits the amount of blood your heart can pump (cardiac output). This deprives your body of blood and oxygen. Eventually, it can cause your heart to stop entirely, a potentially fatal condition called cardiac arrest.

How is cardiac tamponade diagnosed?

Several different tests and methods can help diagnose cardiac tamponade. Healthcare providers are most likely to start with a physical exam. This will include:

• Taking your pulse.
• Checking your blood pressure.
• Checking your breathing.
• Listening to your heart and breathing sounds.
• Checking for a sign called pulsus paradoxus, where your blood pressure drops unusually each time you take a breath.

Hallmark cardiac tamponade signs are those known as Beck’s triad:

• Low blood pressure (hypotension).
• Bulging neck veins.
• Heartbeats that sound distant or muffled when a provider listens through a stethoscope.

However, only 10% to 40% of people with cardiac tamponade have Beck’s triad.

What tests will be done to diagnose cardiac tamponade?

Tests to diagnose cardiac tamponade include:

• Echocardiogram (Echo).
• Chest X-ray.
• Computed tomography (CT) scan.
• Electrocardiogram (EKG).
• Heart catheterization.

How is cardiac tamponade treated?

Treatment for cardiac tamponade requires removing the fluid from around your heart with a procedure called pericardiocentesis. A provider may also need to repair damage related to the fluid buildup.

Which treatment is used for cardiac tamponade?

Cardiac tamponade treatment may include using a needle (pericardiocentesis) or performing surgery.

Surgery may be a better option if:

• An injury caused the cardiac tamponade.
• You have damage that needs to be repaired.
• A needle can’t reach accumulated fluid.
• A provider needs to remove your pericardium.

In especially severe cases, such as when your heart stops because of cardiac tamponade, a provider can do a thoracotomy by the bedside in the emergency room (ER).

Your provider will need to treat the cause of your cardiac tamponade, as well. Depending on what caused your cardiac tamponade and which treatment you had, you may receive pain medications, antibiotics or other medications.

Complications/side effects of the treatment

Pericardiocentesis and surgery can have the following complications:

• Bleeding.
• Injury to your heart’s chambers or surrounding blood vessels.
• Collapsed lung (pneumothorax).
• Air in your pericardium (pneumopericardium).
• Heart attack.
• Pulmonary edema.
• Infection.
• Irregular heartbeat (arrhythmia).
• Injury to nearby organs, including your liver, lungs or stomach.
• Death.

How soon after treatment will I feel better?

You should feel better right away when a provider removes the excess fluid from your pericardium. You may have a drainage tube for a day or two so the fluid can keep draining. Echocardiograms can show how much fluid is left in your pericardium. This helps your provider decide when it’s time to remove the drain.

Can cardiac tamponade be prevented?

Because either diseases or injuries can cause it, cardiac tamponade is extremely difficult to predict and prevent. However, it may be possible to avoid it with early detection and treatment of a pericardial effusion, especially after an injury or with conditions that you know you have.

What can I expect if I have cardiac tamponade?

Your healthcare provider can give you guidance on what you should and shouldn’t do while you’re recovering from cardiac tamponade and any procedure that treats it. If you had surgery, it’s likely that your provider will tell you to avoid physical activity during the healing process.

If a disease is what caused your cardiac tamponade, how you manage it will change depending on your situation. Your provider can guide you on what you can and should do once you go home.

Outlook for cardiac tamponade

If you get quick treatment for cardiac tamponade, you’ll probably have a good outlook. Your prognosis gets worse with a delay in treatment.

How do I take care of myself?

When you go home from the hospital after cardiac tamponade treatment, keep taking medicines your provider prescribed for you. Going to follow-up appointments is important, too. Cardiac tamponade can happen more than once. A provider can keep an eye on the condition that caused it.

When should I see my healthcare provider?

You should have another echocardiogram about one or two weeks after your cardiac tamponade treatment. You’ll also need to have a follow-up appointment with a cardiologist at that time.

When should I go to the ER?

Cardiac tamponade is a medical emergency and needs immediate care. If you have any injury to your chest, especially near your heart, you should seek urgent medical attention. This includes injuries from any impact, whether it penetrates your skin or not. You should also seek urgent medical attention if you’re recovering from cardiac tamponade and any of the symptoms return.

You should also go to the hospital if you had surgery or pericardiocentesis and you show any symptoms of an infection. These include:

• Fever or chills.
• Redness, swelling, pain or warmth around the wound or needle site.

What questions should I ask my doctor?

Questions to ask your healthcare provider may include:

• How often will I need an echocardiogram in the future?
• What are my chances of getting cardiac tamponade again?
• What caused my cardiac tamponade?

A note from Cleveland Clinic

Cardiac tamponade is a serious medical condition, and it’s normal to feel fear or anxiety if you have it. Caring for your mental health can be an important part of recovery. Your healthcare provider can connect you with counseling or other mental health services that can help you.