If the medical profession speaks of pericardial tamponade, the circumstance has occurred that so much fluid has accumulated in the pericardium that there is an impairment of heart function. The heart muscle is constricted from the outside. Such fluid accumulation can be caused by inflammation; the fluid may be clear, but it may also contain pus or blood.
What is pericardial tamponade?
Pericardial tamponade (medical term: pericardial tamponade) is a complication that occurs when fluid accumulates in the pericardium. This results in what is known as pericardial effusion; rarely, air accumulation can also be the cause of a complication, in which case the medical profession refers to it as pneumopericardium. Even small amounts of fluid can obstruct the filling of the ventricle and reduce the stroke volume to such an extent that the life of the affected person is endangered. Subsequently, there is a reduced blood flow in the coronary arteries – this circumstance leads to an insufficient oxygen supply (hypoxia). In the further course, a heart failure (cardiac insufficiency) occurs. The fluid may be blood (hemopericardium), pus (pyopericardium), or serous fluid (hydropericardium) or a chyle (chylopericardium). The accumulation of fluid creates pressure so that the heart is constricted and compressed, impairing its function.
Causes
Pericardial tamponade is usually caused by a perforation of the pericardium. The pericardium is a thin sac that surrounds the heart. The cavity that is around the heart fills with blood or other fluids so that the heart is compressed. If the fluid presses on the heart, less and less blood gets to the heart, causing a shortage of blood. Shock ensues, followed by organ failure and, ultimately, cardiac arrest. Possible causes of pericardial tamponade include gunshot or stab wounds. Other conceivable causes include trauma as a result of an accident at work or on the road, or an attack on the pericardium by lung cancer, breast cancer or other types of cancer. Pericarditis, radiation doses to the chest, hypothyroidism, and chest tubes used after heart surgery can also cause pericardial tamponade.
Symptoms, complaints, and signs
If pericardial tamponade occurs, the affected person complains of the following symptoms: The patient suffers from anxiety and restlessness; blood pressure is very low. Sometimes the patient feels weak, complains of chest pain, which may also radiate to the neck, back or shoulders. Sometimes breathing difficulties are noticeable, as well as problems taking deep breaths. Affected individuals suffer from accelerated breathing, may faint and pass out, or complain of a persistent feeling of dizziness.
Diagnosis and course
Pericardial tamponade is usually noticeable by three signs, which the physician detects during the physical examination. These are what is known as Beck’s triad, which has the following characteristics: Low blood pressure and very weak pulse, with a reduced blood volume; enlarged neck veins and an accelerated heartbeat. If it is suspected to be pericardial tamponade, further tests are performed so that the physician can confirm his suspicion. First comes an echocardiogram (heart ultrasound); during this examination, the physician can determine if dilatation of the pericardium has already occurred. Sometimes he can also determine whether the heart valves have collapsed – due to the insufficient amount of blood. If the physician has X-rays of the thorax taken, he can sometimes also detect an enlarged heart; this circumstance also indicates pericardial tamponade. Other tests include thoracic computed tomography (CT), during which the physician can determine if there have been any cardiac changes or fluid collections. Magnetic resonance imaging (MRI) makes it possible to see the structure of the heart. Coronary angiography allows the physician to check blood flow; electrocardiogram is used to check the heartbeat. The chance of survival depends on the time of diagnosis. Sometimes the cause also plays a significant role.If pericardial tamponade is detected relatively quickly and subsequently treated without delay, the prognosis is good. However, if the physician is unable to drain the fluid from the pericardium in time, shock will result and, subsequently, organ failure. Sometimes these circumstances can lead to the patient’s death.
Complications
Pericardial tamponade results in cardiac symptoms that, in the worst cases, can be fatal to the patient. Usually, the function of the heart is severely affected by the disease. As a result, blood pressure drops and anxiety and a reduced ability to cope with stress occur. It is not uncommon for patients to also suffer from chest pain and shortness of breath, so that pericardial tamponade can be mistaken for a heart attack. It is not uncommon for the breathing difficulties to lead to panic attacks or sweating. The low blood pressure can lead to a loss of consciousness or dizziness. The loss of consciousness may cause the patient to injure himself if he falls. The quality of life of the affected person is extremely limited and reduced by the pericardial tamponade. The weak pulse usually limits the ability to perform various activities. If pericardial tamponade is not treated in time, the patient will die. Usually, no particular complications occur during the treatment. However, causal treatment of the disease is also necessary afterwards to eliminate the trigger for pericardial tamponade.
When should you go to the doctor?
If physical symptoms such as difficulty breathing, disturbances in consciousness, and dizziness are noticed, pericardial tamponade may be present. Other warning signs that indicate heart disease include restlessness, low blood pressure, and chest pain that may radiate to the neck, back, and shoulders. If these symptoms are noticed, a physician must be consulted. This is especially true in the case of persistent symptoms that increase in intensity as they progress or significantly affect well-being. In case of shock or heart failure, the emergency physician must be called. Until medical assistance arrives, provide first aid to the affected person. Pericardial tamponade particularly affects lung cancer or breast cancer patients, persons with pericarditis and accident victims. There is also an increased risk of developing pericardial tamponade after heart surgery or radiation treatment. Patients at risk should take these symptoms particularly seriously and talk to their family doctor immediately. He or she can clarify the symptoms and, if necessary, refer the patient to a cardiologist or a specialist in internal medicine.
Treatment and therapy
Pericardial tamponade is a medical emergency. The patient is treated as an inpatient. Treatment is given in two steps: Initially, the physician attempts to relieve pressure from the heart. Once the heart is relieved, treatment is given to the condition that triggered the pericardial tamponade. It is important that the patient is stable. The physician places a drain to ensure that the fluid is drained from the pericardium. Sometimes a partial removal of the pericardium can be done if too little fluid is drained; the partial removal also provides relief to the heart. The patient is given supplemental oxygen, medications and fluids to raise blood pressure. Once the physician has brought the pericardial tamponade under control and stabilized the patient, further tests can be performed. During these tests, the physician attempts to identify the cause of the pericardial tamponade and subsequently treat the causative disease.
Outlook and prognosis
Without medical care for the patient, the prognosis of pericardial tamponade is unfavorable. The functional activity of the heart is limited by the stresses. As it progresses, organ failure occurs, leading to premature death of the affected individual. With timely and adequate medical treatment, the patient’s survival can be assured. The fluid is drained in a professional intervention. In some cases, part of the pericardium is removed. This results in relief of the pericardium and the heart activity normalizes.Nevertheless, the quality of life of the person affected by pericardial tamponade is also limited in the long term due to reduced physical performance. If the treating physician succeeds in regulating the blood flow sufficiently, the prognosis improves significantly. Nevertheless, lifelong monitoring of cardiac activity is necessary in order to be able to react immediately in the event of changes or abnormalities. The cause of the pericardial tamponade must be found and corrected so that the patient’s overall health can be optimized. Failure to do so will result in a re-accumulation of the fluid in the pericardium as it progresses. Complete recovery or healing can only be expected in very rare cases. In most cases, there is a chronic disease that leads to the triggering of the fluid accumulation.
Prevention
Pericardial tamponade usually cannot be prevented. If signs suggesting pericardial tamponade are present, a physician should be contacted immediately – there is an acute danger to life.
Follow-up care
In most cases of pericardial tamponade, only a few measures and options for aftercare are available to those affected. It is crucial to make a quick diagnosis so that the heart can be treated properly. Only early diagnosis with subsequent treatment can prevent further complications and discomfort. In the case of pericardial tamponade, the focus is therefore on early detection, so a doctor should be consulted at the first signs of this condition. In most cases, pericardial tamponade is treated by surgical intervention. After the operation, the patient should rest and take it easy. Stressful or physical activities should be avoided in order not to put unnecessary strain on the heart. In most cases, it is also necessary to take medication to support the treatment. Care must be taken to ensure that the medication is taken correctly and in the correct dosage. If there are any questions or uncertainties, the doctor must be consulted. The doctor should also be asked for advice if side effects or interactions occur. In some cases, pericardial tamponade also reduces the life expectancy of the affected person.
Here’s what you can do yourself
As a rule, pericardial tamponade cannot be treated by self-help means. In this case, interventions by a doctor and taking medications are necessary to combat the discomfort and symptoms. If an affected person suffers from pericardial tamponade and may lose consciousness, an emergency physician must be called immediately. The affected person can be cared for by first aid measures until the emergency physician arrives. Furthermore, the affected person must also be in a stable lateral position. Patients suffering from pericardial tamponade must not exert their bodies excessively and unnecessarily. This can prevent or alleviate many complaints. Calm and, above all, regular breathing also has a positive effect on the course of the disease. In most cases, patients with this disease are dependent on a stay in a hospital. In this case, the support of friends and family can also significantly alleviate the psychological discomfort and contribute to the stability of the patient. In most cases, complications can be avoided if the condition is treated early, so the patient’s life expectancy for pericardial tamponade is not reduced.
