Why Fluid Around the Heart is Deadly Serious

Cardiac tamponade caused dysfunction of the heart due to fluid around the heart. Cardiac tamponade causes decreased cardiac output. The patient becomes hypotensive because the cardiac output cannot meet the demands of the body.

Cardiac tamponade is the effect of pericardial effusion. Cardiac tamponade implies impairment of cardiac function due to pericardial effusion. Cardiac tamponade is an emergency situation. Tamponade is a functional deficit/physiologic impairment of the heart and is a sub-set of pericardial effusion.

Usually there is no fluid between the pericardium and the heart. With cardiac tamponade, when the heart expands, it can’t fully expand because fluid is restricting it. Cardiac tamponade is a medical emergency and needs to be relieved right away.

The Cause of Cardiac Tamponade

Pericardial effusion is the buildup of extra fluid in the space around the heart. If too much fluid builds up, it can put pressure on the heart. This can prevent the heart from pumping normally. A fibrous sac called the pericardium surrounds the heart. When cardiac tamponade exists, the heart cannot expand enough. Bad kidneys can cause pericarditis. Things build up in the pericardium with bad kidneys.

Rapid fluid accumulation in the pericardium can cause cardiac tamponade, a severe compression of the heart that impairs its ability to function. With cardiac tamponade, the pericardial sac fills with fluid which compresses the right ventricle, so the right ventricle can’t fill properly. The main thing you see if collapse of the right ventricle during diastole. If that occurs, it is tamponade until proven otherwise. Tamponade is usually a clinical diagnosis.

A rapidly progressing pericardial effusion can cause tamponade. Even a small pericardial effusion can kill someone. It is the rate of the growth of the effusion that determines the outcome.

The Symptoms of Cardiac Tamponade

Cardiac tamponade has the following symptoms:

• Anxiety and restlessness
• Low blood pressure
• Chest pain
• Trouble breathing

There are 3 classic signs of cardiac tamponade (called Beck’s Triad): (1) low blood pressure in the arteries; (2) muffled heart sounds; and (3) swollen or distended neck veins (distended veins). With pulsus paradoxus, the patient takes a deep breath and the blood pressure goes down, rather than up. This is a sign of cardiac tamponade.

The Treatment for Cardiac Tamponade

If you see a pericardial effusion and the patient is hypotensive, you need a bedside echocardiogram to check for collapse of the right lung and check for pulsus paradoxus.

The treatment of cardiac tamponade is simple: take 50 cc syringe with 3-inch needle; this can be done blindly or with ultrasound guidance. Insert the needle under the sternum and pull out on needle. A pericardiocentesis does not require a surgeon or an operating room. There is no need to go the catheterization lab.

Pericardiocentesis is a procedure done to remove fluid that has built up in the sac around the heart (pericardium). It’s done using a needle and small catheter to drain excess fluid. A “pericardial window” drains excess fluid to the abdomen/stomach.