Pericardial tamponade

Definition

Pericardial tamponade is an acute and life-threatening clinical picture in which fluid accumulates inside the pericardium, which can be accompanied by severe functional limitations of the heart muscle. The heart muscle is surrounded by several layers of connective tissue. The so-called pericardium, also known as the pericardium, shields the heart from the remaining organs in the thorax and stretches and moves in pulse synchrony with the heartbeats.

Between the pericardium and the heart there is about 20-50ml of a lubricating fluid to allow the heart to move in the pericardium without friction. Various causes can cause fluid to multiply and accumulate in the pericardium. They can be present without symptoms as a side effect of many diseases. However, if a functional impairment and thus life-threatening symptoms occur, this is called tamponade.

Treatment

The treatment of pericardial tamponade must be carried out early and professionally by intensive care medicine. The aim of the therapy is to alleviate the acute symptoms and to prevent a recurrence. In the acute situation, fluid must often first be supplied to the body via an infusion in order to maintain the heartbeat and the supply of blood to the body.

In order to relieve the heart and restore the possibly restricted heart function, the pericardium can be punctured to drain the effusion. Puncture of the pericardium only makes sense if the underlying disease does not lead to immediate further pericardial tamponade. Depending on the causative disease, a puncture may be sufficient as the sole therapy or may only last for a few minutes.

In any case, an adequate therapy of the underlying disease, for example myocardial infarction, aortic dissection or pericarditis, must follow in order to avoid further complications. Puncture of the pericardium is a high-risk procedure that should only be carried out under intensive inpatient monitoring with regard to the function of the heart, circulation and respiration. During this procedure, the fluid-filled space between the pericardium and the heart muscle is punctured under ultrasound guidance with a needle to drain the fluid.

In pericardial tamponade, the puncture is performed frequently in order to relieve the acutely distressed heart and to restore circulatory function. At the same time, however, the effusion can be used to determine whether there is a bloody effusion or a purulent effusion as a result of an infection. Even individual pathogens can be identified from the fluid obtained. Puncture of the pericardium is usually performed with adequate anesthesia and sedation.