Cardiac tamponade symptoms and treatment

Nature cunningly provided for a kind of protection of the heart muscle, “putting” it in the outer shell – the pericardium. This “clothing” protects the heart muscle from mechanical influences, infectious agents, the first to meet them in its path. It envelops the heart loosely, and normally there is a cavity between the pericardium and the heart.

The cavity has a small amount of a special fluid of serous origin, a kind of lubricant that facilitates the friction of the pericardial leaves, its a little 20-25 milliliters. The outer shell or heart bag also supports the cardiac “motor” – it prevents its displacement relative to other organs, does not allow it to overstrain and stretch unnecessarily during operation. These are important functions of the outer heart membrane.

Classification

Cardiac tamponade may be different. The prognosis depends on the exact determination of the type of disease. There are such types of it:

  1. Sharp. It develops rapidly, and its symptoms are pronounced. Up to 250 ml of fluid is poured into the pericardial cavity. It is very difficult to predict the course of the disease. A person needs urgent help from doctors.
  2. Chronic The pericardial space is filled gradually. In the end, the liquid there is 1-2 liters. Here the forecast is more favorable, since a life-threatening condition does not occur too quickly. Doctors have time to solve the problem.
  3. Spontaneous. Tamponade develops due to defects in the heart membranes or vessel walls.

The type of disease depends on the prescribed therapy, as well as its effectiveness. Tamponade has a uremic, bacterial, viral or tumor character.

2When the “clothes” are not in size or how the tamponade develops

Let’s figuratively imagine what happens to the heart with tamponade . How would you feel in clothes 2 sizes smaller? You would be cramped. You would not be able to carry out the daily workload, at first you would apply maximum effort to do the work, and then, tired, take it off, tear it apart, could not bear the discomfort . The heart also feels with tamponade, since in this condition there is an excessive accumulation of fluid in the pericardial cavity .

When this cavity is filled with liquid, the pressure in it rises, the heart becomes compressed, its ability to contract decreases, the venous inflow to it decreases, and cardiac output decreases. Cardiac tamponade is a life-threatening complication of pathological conditions on the part of the cardiovascular system. How quickly this condition progresses depends on the rate of fluid accumulation and its volume in the pericardial cavity.

If the accumulation of fluid occurs quickly, then even 230-240 ml of fluid is sufficient for the development of tamponade, with a slow accumulation of fluid, the pericardium has time to stretch, adapt, and the tamponade occurs when the fluid volume exceeds 2 liters, and sometimes even 3 liters can fit in a heart bag . A tamponade can develop rapidly, dramatically, literally in a couple of hours, or even within a few minutes, in some cases it develops slowly, and then we are talking about subacute compression of the heart.

But regardless of the rate of compression to which the cardiac muscle is subjected, the mechanisms of its development are the same: the pressure inside the pericardial is rapidly increasing, pressure by the liquid causes a decrease in the volume of the left ventricle and other heart chambers, an increase in diastolic and a drop in systolic pressure of the ventricles, a sharp decrease in the volume of shock, cardiac ejection.

So what causes the compression of the heart muscle? What diseases and pathological conditions can lead to a life-threatening disorder?

Causes of

The causes of cardiac tamponade are:

  • Open or closed chest trauma, accompanied by organ damage.
  • Radiation exposure.
  • A neoplasm of a malignant or benign nature.
  • Excessive dehydration.
  • Blood pressure problems.
  • Hypothyroidism or other impaired functionality of the endocrine system.
  • Myocardial infarction or rupture of the heart.
  • Long-term use of blood thinners.
  • Hemodialysis, provoking renal failure.
  • The prolonged course of chronic pathologies.
  • Myxedema.
  • Rheumatism.
  • Tuberculosis.
  • Severe fungal infection.
  • Rupture of stratified aortic aneurysm.
  • Surgical removal of myocardial tissue or sounding of the heart chambers.
  • Leukemia.

The chronic type of tamponade often causes systemic pathologies that lead to damage to the connective tissue. Particular attention should be paid to the development of the disease in babies up to a year.

Cardiac tamponade is a pathological condition that is accompanied by a rapid violation of hemodynamics as a result of fluid accumulation in the pericardial cavity and a sharp increase in pressure inside the pericardium. Such processes become the cause of heart failure, which is associated with a lack of diastolic blood supply to the ventricles of the heart and a decrease in the release of blood into the bloodstream.

Cardiac tamponade is the cause of the occurrence of several syndromes that are life-threatening for a person, among which it is worth noting cardiac arrest, cardiac shock, acute heart failure and others.

The causes of cardiac tamponade are conditions that lead to the accumulation in the pericardial cavity of a liquid of biological origin (blood, pus, effusion, lymph, exudate and the like).

Most often in clinical practice, acute cardiac tamponade is diagnosed, which develops against the background of hemorrhage in the intrapericardial space, which is characteristic of the following pathological processes in the body:

  • mechanical damage to the chest with penetrating wounds of the membranes of the heart;
  • poorly performed medical diagnostic and therapeutic measures (probing and catheterization of the heart muscle, surgery, myocardial biopsy);
  • dissection of the aortic aneurysm;
  • hemorrhage into the pericardial cavity after myocardial infarction, which was accompanied by spontaneous rupture of the heart wall;
  • long-term use of medications from the group of anticoagulants.

There are other reasons for cardiac tamponade, when a certain amount of serous or purulent exudate, effusion, and the like accumulate in the intrapericardial space:

  • infectious pericarditis and myocarditis;
  • chronic lung diseases that are accompanied by respiratory failure (tuberculosis, bronchiectasis, lung cancer);
  • acute and chronic renal failure;
  • malignant tumors of the chest cavity and metastasis;
  • lymphomas in the chest cavity;
  • systemic and endocrine diseases (myxedema, lupus erythematosus, scleroderma).

Depending on the duration of the development of the pathological condition and the severity of symptoms, it is customary to distinguish acute and chronic cardiac tamponade. Acute cardiac tamponade occurs suddenly and is characterized by a pronounced clinical picture, frequent signs of which are:

  • pain and discomfort behind the sternum, which is accompanied by a fear of death;
  • a sharp decrease in blood pressure, cold sweat, fainting state, as a manifestation of a shock state;
  • increasing shortness of breath, rapid shallow breathing;
  • severe hypertension in the venous bed;
  • cyanosis of the skin and swelling of the jugular veins;
  • psychomotor agitation, collapse.

According to experts, the Beck symptom triad, which includes visual expansion of the veins in the neck, a decrease in blood pressure and dull heart sounds, is a classic manifestation of acute cardiac tamponade.

Sometimes the Beck triad may be the only confirmation of the development of a pathological condition and indicate accumulation of fluid in the pericardial cavity, in the absence of other manifestations of the disease.

For cardiac tamponade, the symptoms of which develop gradually, it is characteristic:

  • shortness of breath during physical exertion, and with time and at rest;
  • general weakness, loss of working capacity;
  • appetite disturbance;
  • accumulation of free fluid in the abdominal cavity (ascites);
  • enlarged liver;
  • heaviness and discomfort in the right hypochondrium;
  • persistent arterial hypotension;
  • pallor of the skin.

First of all, if a pathological condition is suspected, the doctor examines the patient, in which he identifies the specific symptoms of the disease and identifies the main syndromes. Further, in order to accurately determine the signs of cardiac tamponade, the following clinical and laboratory tests are prescribed to the patient:

  • electrocardiographic examination allows you to determine some nonspecific signs of the disease, exclude the occurrence of sinus tachycardia or confirm the decrease in voltage, myocardial infarction (read more here);
  • ultrasound or echocardiography is by far the most effective and fastest method for diagnosing cardiac tamponade, with which you can confirm the presence of free fluid in the pericardial cavity, diagnose hemodynamic disorders, as well as collapse of the right heart and the presence of myocardial ischemia;
  • X-ray diagnostic methods are able to determine the extended borders of the heart and the roundness of its shape, as well as confirm the absence of venous congestion in the lungs.

Cardiac tamponade refers to complex emergency conditions, the treatment of which is carried out in an intensive care unit.

To remove excess fluid from the pericardial cavity, the patient is punctured pericardial space under local anesthesia.

The extracted exudate is necessarily sent to the laboratory for bacteriological and cytological studies, the further management tactics of the patient depend on the results of which.

In order to prevent the development of an infectious process, the victim is given antibacterial agents and hormones.

Hemodynamic parameters can be resumed with the help of intravenous infusion of plasma preparations, colloidal solutions, nootropics.

In case of traumatic damage to the pericardium, the patient undergoes surgery in the form of pericardiotomy or subtotal percardioectomy.

Surgical treatment of tamponade is an operational method of eliminating the problem and is carried out exclusively under general anesthesia. Pericardiotomy implies a specific technique for drainage of the cavity of the affected pericardium, followed by revision of the space and removal of the causative foci.

Subtotal pericardiectomy is a radical operation by which surgeons resume the normal functioning of the heart muscle by removing scars, calcifications or malignant neoplasms on the pericardium.

Prevention of tamponade is carried out by performing the following measures:

  • timely diagnosis and adequate treatment of chronic conditions, which can cause the development of hemopericarditis and tamponade;
  • strict adherence to the protocol of minimally invasive diagnostic measures and compliance with all asepsis rules;
  • control of hemodynamic indicators of blood status with prolonged use of drugs from the group of anticoagulants;
  • prevention of chest injuries;
  • periodic preventive examinations by a specialist for patients who are at risk for the development of cardiac tamponade.

Doctors warn that untimely seeking medical help with cardiac tamponade will necessarily lead to death. Only early diagnosis of a pathological condition and qualified treatment in a hospital will allow specialists to save the life of such a patient.

If the treatment was timely, and the pathological process did not manage to be complicated by acute heart failure with cardiac arrest, then, according to statistical studies, almost 80% of patients after all therapeutic measures are successfully discharged from the hospital and continue to lead a normal lifestyle.

Naturally, after discharge from the hospital, such people are strictly forbidden to give the heart muscle to intense physical activity, a special diet and supervision by a cardiologist are recommended.

Cardiac tamponade is a pathology of hemodynamics. Between the external membrane of the heart and the epicardium, fluid accumulates. Clinical syndrome can trigger acute heart failure, shock, and a sudden cessation of cardiac activity.

The main causes of cardiac tamponade include: damage to the integrity of the sternum or heart as a result of a blunt injury or wound, hemorrhage after cardiac surgery, rupture of aortic aneurysm, chronic diseases, acute and viral infections, post-radiation or idiopathic pericarditis, tuberculosis, terminal stage of lung or breast cancer lymphoma.

With fluid accumulation between the lining of the heart and the epicardium, cardiac output decreases, and systemic venous congestion occurs. The patient feels discomfort in the chest, shortness of breath comes, fear of death and anxiety appear.

Symptoms may be accompanied by sudden weakness, fatigue, drowsiness, profuse sweating, significant blanching of the skin. Blood pressure drops sharply, venous hypertension occurs, and the heart tone becomes deaf. The classic Beck triad is characteristic of cardiotamponads only.

However, much more often, clinical symptoms increase progressively. The Beck Triad is absent. Symptoms are similar to progressive heart failure. Sometimes tamponade is asymptomatic. This is the most dangerous form of pathology, since the serous membrane of the heart can become inflamed, which causes a serious threat to the patient’s life.

Compression of the heart cavity leads to disruption of the heart. A fluid volume of more than 250 ml is considered critical. The heart bag is stretched and may burst. In acute tamponade, the integrity of the heart muscle and aorta is impaired. The patient falls into hemorrhagic collapse.

Cardiac tamponade: signs, course, diagnosis, first aid, treatment

Cardiac tamponade is a pathology of its hemodynamics, in which there is an accumulation of fluid in the pericardial cavity, that is, between the sheets of the pericardium (the outer membrane of the heart from the connective tissue) and the epicardium. For example, tamponade of the heart with blood can form due to bleeding in the heart bag with open and closed chest injuries or as a result of invasive and minimally invasive procedures on the heart.

Compression of the heart cavities and increased intrapericardial pressure lead to difficulty in normal heart contractions, impaired diastolic filling of the ventricles and a significant decrease in cardiac output. As a result, cardiac tamponade can cause acute heart failure, a shock state and complete cessation of cardiac activity.

The normal volume of fluid in the heart bag does not exceed 20-40 ml. The condition in which the liquid volume reaches 250 ml may already be critical.

Sometimes this volume reaches even 1000 ml or more: this is possible if the effusion increases gradually and the heart bag has time to stretch, thus adapting to the growing volume of exudate.

Acute cardiac tamponade progresses rapidly, and its course is unpredictable. So, in case of violation of the integrity of the aorta or heart muscle, the patient can suddenly lose consciousness and fall into hemorrhagic collapse, in which urgent surgical operation is necessary – in order to avoid death.

Different types of breaks

  1. Heart rupture and bleeding in the pericardial cavity. The causes of rupture of the heart muscle or rupture of the myocardium are a complication of myocardial infarction, in which both internal ruptures of the papillary muscle or papillary muscle, interventricular septum, and external ruptures of muscle tissue can be observed. Heart attack is the most common cause. Other causes of heart rupture include penetrating heart wound, aortic rupture, tumor invasion into the cardiac cavity with rupture and bleeding, arteries inside the pericardial can rupture. A condition in which blood accumulates in the pericardial cavity is called hemotamponade.
  2. Exudative pericarditis, not necessarily blood accumulates in the pericardial cavity, lymph, pus, exudate can accumulate.
  3. Profuse bleeding in a heart bag with hemorrhagic diathesis, an overdose of anticoagulants – drugs that make blood liquid.
  4. Bleeding after surgery on the heart.

What are these symptoms indicating that the heart muscle is constricted?

Signs and symptoms

With cardiac tamponade, the symptoms appear in different ways. It all depends on the form of pathology. The following signs of the disease can be distinguished:

  • Significant deterioration in well-being.
  • Pain and discomfort in the chest area.
  • Excessive psychological stress.
  • Lack of air, shortness of breath.
  • Cold sweat.
  • Malaise and weakness.
  • Impaired heart rate.
  • Cyanosis of the skin (its acquisition of a blue hue).
  • Increased anxiety and fear of death.
  • Disturbed appetite.
  • A muffled heart tone is heard, and there is also the noise of pericardial friction.

In difficult cases, the patient has dizziness, loss of consciousness, as well as hemorrhagic collapse. The chronic form is characterized by an increase in the volume of veins, a change in the size of the liver, difficulty in breathing during physical exertion.

4 Clinical picture

Dyspnea, sharp increasing general weakness

The clinic for patients with cardiac tamponade is very characteristic. An experienced doctor can diagnose tamponade even without instrumental studies. Symptoms of heart tamponade are as follows:

  1. Increasing shortness of breath
  2. Fear of death
  3. Palpitations
  4. Dizziness, possibly loss of consciousness in acute tamponade,
  5. A sharp increasing general weakness, even weak physical exertion for the patient, is impossible
  6. Severe pain in the heart region of a pressing nature,
  7. Cough,
  8. Hoarseness
  9. Inability to swallow – dysphagia.

Coughing with tamponade of the heart is the result of compression of the trachea, hoarseness occurs when infringement of the recurrent nerve occurs, and with compression of the esophagus, dysphagia is observed. These symptoms are characteristic when the effusion is very significant. The above symptoms are characteristic of a rapidly developing, acute cardiac tamponade.

  1. Pain in the right hypochondrium;
  2. Nausea, periodically vomiting;
  3. An increase in the volume of the abdomen and swelling of the lower extremities.

Urgent care

With serious heart pathologies, the patient sometimes requires urgent medical attention. Cardiac tamponade often leads to death if the patient does not receive timely care. An attack can happen at any time. If a person becomes ill at home, he needs to provide emergency care and call a doctor.

At the time of the attack, one should not give the victim any drugs, since the blood pressure will decrease even more. It is important to provide the person with maximum comfort. After the arrival of doctors, it is necessary to describe in detail and accurately the state of the person.

First of all, in a hospital, pericardial puncture is done. A needle with an expanded end is inserted into this area and excess fluid is pumped out. The injection site is the area of ​​the left 7th rib. The needle is inserted 1,5 cm deep, goes up and pushed even deeper (3-5 cm). With the right procedure, fluid begins to flow.

The procedure is carried out under the supervision of an ultrasound or X-ray. The operation can only alleviate the patient’s condition for a while. If the cause is not resolved, then the problem will return. After the puncture, the pericardial cavity is washed with sclerotizing, antiseptic or antibiotics. Commonly used drugs are Hydrocortisone, Prednisone.

With cardiac tamponade, emergency care reduces the risk of death.

7 How to help the patient?

Appearance of a patient with cardiac tamponade

Patients with tamponade of the heart take a position in which they feel relieved: they often sit, leaning forward, sometimes kneeling, resting their forehead on the pillow. Their skin is pale, with a gray tint, often covered with cold sweat. Neck, face can swell, covered with sticky sweat. The pulse is barely felt, the pressure drops sharply.

Upon examination of the border, the cardiac expand sharply, the heart beat disappears, the heart sounds are extremely deaf, the frequency of contractions rolls over. This indicates the extremely dangerous condition of the patient, the development of an acute, critical condition, the patient immediately needs emergency medical care. If cardiac tamponade develops gradually, enlargement and soreness of the liver, ascites are determined.

Emergency therapy for tamponade

First of all, calling for emergency medical care. If a person became ill at home, there were complaints, characteristic of cardiac tamponade, you should not give him the first medicines that came to his hand: nitroglycerin and others. They can further lower blood pressure and worsen the condition of the patient. After examination, the doctors, having determined the indications, perform a pericardial puncture – they insert the needle into a specific point on the chest and pump out the fluid.

The puncture is carried out under the supervision of ultrasound or x-ray control. But this is a temporary measure to alleviate the condition of the patient. It is necessary to identify the cause that led to tamponade and eliminate it: surgically or treating the underlying disease. Success in the treatment of cardiac tamponade is considered to be the elimination of the cause that caused it, and well-being, stabilization of the patient’s condition.

Traditional therapy

Therapy is considered successful if the cause of the development of the pathology is eliminated, and the condition is stabilized. The patient’s condition should noticeably improve.

After acute cardiac tamponade is stopped, supportive therapy with medication is performed. The patient receives an infusion solution: metabolic drugs or blood plasma.

To restore normal processes of nutrition and metabolism in the myocardium, to improve tissue regeneration, doctors prescribe Mildronate, Carnitine to a person. If complications arise in the patient due to the filling of the pericardium with liquid, then the treatment is directed to stopping the pathological conditions.

If the cause of the tamponade has been eliminated successfully, then after a few days the patient is discharged from the hospital and continues therapy on an outpatient basis at home.

6 Instrumental diagnostics

In the diagnosis, instrumental methods are used to clarify the diagnosis.

  1. ECG. On the cardiogram, you can see a sharp decrease in the amplitude of the teeth, the smoothness of T, the alternation of P, T, QRS;
  2. Echocardiography is used urgently for indications of cardiac tamponade. This method is of great importance in the diagnosis of tamponade. The signs of which are:
    • a decrease in the degree of decay of the inferior vena cava upon inspiration (less than 50%),
    • reduction of the cavities of the lower heart chambers,
    • discrepancy of the leaves of the pericardium;

X-ray cardiac tamponade

So, it is already possible to diagnose cardiac tamponade clinically. The clinic allows you to suspect a diagnosis, which is confirmed by urgent echocardiography, measurement of CVP. If these instrumental diagnostic methods are not available, an ECG is performed.

Is surgery necessary?

Treatment of cardiac tamponade is not only conservative. If the risk of relapse is high, then an operation is performed. An indication for the procedure is: heart rupture, calcification or cicatricial changes in the pericardium, chronic formation of exudate in the pericardial sac.

The patient is usually prescribed such an intervention:

  1. Pericardiotomy The wall of the pericardium is dissected in order to drain its cavity, drain excess fluid, as well as identify pathological foci.
  2. Subtotal pericardectomy. Complete removal of the fragment, with the exception of the part adjacent to the rear of the chambers.

After surgery, the patient needs recovery. It is important to avoid heavy physical exertion, stressful situations, eat right.

Drainage features

The pericardium is a heart bag that has the ability to stretch, so the clinical picture is changing. With its rapid filling with liquid, the patient develops a shock condition. Immediate drainage is required.

Liquid removal cannot be carried out quickly. If 1 liter is present in the pericardium, then the elimination procedure lasts about 40 minutes. Otherwise, the patient’s blood pressure drops significantly. Hypotension is able to last a week. In this case, the patient’s response to therapy is negligible.

This reaction is associated with overloading of the right heart chambers, impaired restoration of myocardial muscle functionality.

Early complications

If treatment of cardiac tamponade was not performed on time or was ineffective, then the patient develops complications. They appear both at the time of direct filling of the organ with blood, and some time after that. Unpleasant consequences include:

  • Arrhythmia.
  • Myocardial infarction.
  • Cardiogenic shock.
  • Sudden death.

The chronic course of the disease causes late complications:

  • Fibrous pericarditis (inflammation of the connective tissue of an organ bag).
  • Violation of impulse conduction between the ventricles and atria.

The consequences are also given by pericardial puncture. The patient may develop cardiac sclerosis. With the timely detection and proper treatment of pathology, the prognosis is favorable.

Prevention of pathology

The causes and symptoms of cardiac tamponade should be known to those people who have an increased risk of developing cardiac pathologies.

The presented disease can be prevented, but for this you need to follow these preventive measures:

  • Anticoagulants and other cardiological drugs should be taken only according to the instructions and after consultation with the doctor.
  • In time to treat any infectious and inflammatory diseases.
  • Avoid injury to the chest.
  • Entrust invasive cardiological procedures to professionals only.
  • Eat properly and rationally.

It is difficult to talk about individual consequences, since the causes of the occurrence are different, and not all of them can be completely eliminated.

To avoid death or serious consequences, it is necessary to undergo timely diagnosis and therapy of cardiac diseases. You will also have to be constantly monitored by a doctor.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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