By: Prof. Dr. Seyed Saeid Zamanieh Shahri, MD and Prof. Dr. Sonia Sayyedalhosseini, MD

What is a cardiac tamponade?

Cardiac tamponade is the medical name for one of the problems that can occur for the heart, and this problem occurs as a result of fluid accumulation in the outer layer of the heart (pericardium) with increasing pressure to the point that the heart function is impaired.

Cardiac tamponade is an emergency condition caused by the pressure throughout the heart by blood, pus, gas, and fluid accumulated in the pericardial space, which reduces the inflow to the heart, reduces the volume of the stroke, and generally causes Hemodynamic disturbances occur in the body so it is one of the causes of asystole (no pulse or smooth line on the ECG).

Signs and symptoms Cardiac tamponade

Cardiac tamponade disrupts the heart’s ability to pump blood through the body, resulting in poor blood circulation.

This condition can lead to chest pain and dizziness. The three classic signs of cardiac tamponade, which doctors refer to as Beck’s triad, are:

1. Reduce arterial blood pressure

2. Presence of the heart murmur

3. Swelling of the jugular veins

However, in addition to these three main symptoms, people with cardiac tamponade may also experience the following symptoms:

• Weak pulse
• Cyanosis of body extremities and decrease in surface body temperature
• Dizziness
• Increase of heart rate
• Faint
• Drowsiness
• Anxiety
• Severe pain in the chest, back, abdomen or shoulders
• Shortness of breath

Causes of cardiac tamponade

• Neoplasia
• Idiopathic or viral pericarditis
• Uremia
• Invasive heart operations (especially cardiac catheterization, placement of pacemakers inside the heart)
• Rupture of the free ventricular wall following MI (the most common cause in CCU)
• Bacterial infections and tuberculosis

Clinical manifestations of cardiac tamponade

1. Lower blood pressure

2. Increased central venous pressure (CVP)

3. Beck Triad

Depending on the course of the disease, its manifestations are somewhat different and in acute and severe cases, syncope and shock are the main symptoms, and in milder cases of the disease with restlessness, weakness and lethargy, tachypnea, palpitations, cold extremities, shortness of breath and chest pain.

Chronic disease usually presents with signs and symptoms of heart failure. Evidence of right ventricular failure is more pronounced than left ventricular failure, and therefore its main manifestations are peripheral edema, ascites, hepatomegaly, and signs and symptoms of decreased cardiac output (weakness and lethargy). In general, increased central venous pressure (CVP) , Relatively clear lungs, weak heart sounds, and paradoxical pulse are symptoms of pericardial tamponade.

Increased central venous pressure (CVP)

In cases where there is no restriction on atrial and ventricular dilatation, central venous pressure decreases at the time of inhalation and is clinically characterized by jugular vein collapse, but in compressive pericarditis and sometimes tamponade, CVP not only does not decrease but may increases which is called the Kussmal`s Sign.

Pulses Paradox

Normally systolic blood pressure (SBP) decreases during the inhalation, usually less than 10 mmHg. Pulse is the paradox when this decrease in blood pressure during the inhalation is more than 10-20 mmHg.

The best way to determine the presence of a paradoxical pulse is to measure arterial blood pressure directly, but in the clinic it can be detected by using a standard sphygmomanometer. To do this, first set the sphygmomanometer around the patient’s arm and then fill it up to 20 mmHg above SBP. Then gradually lowered the pressure until the first sound can be heard only during the breath, and at this level the blood pressure is recorded and again the pressure gradually decreases again until the first sound is heard both in the inhale and in the exhale. The difference of this point of pressure from the previous pressure will be the rate of paradoxical pulse.

How to diagnose cardiac tamponade

To diagnose this problem, your doctor will look for Beck’s triad symptoms in the first place. The doctor does this by examining the person’s blood pressure, listening to the heartbeat, and examining the appearance of the body’s arteries.

Your doctor will likely order the following diagnostic tests to confirm the exact diagnosis of cardiac tamponade:

1. Echocardiogram

2. Chest X-ray

3. Electrocardiogram (ECG)

4. Computed tomography (CT) scan

5. Magnetic Resonance Angiogram (MRA)

In addition to the above tests, your doctor may perform a blood test to measure red and white blood cell counts. Blood tests may also detect higher levels of specific enzymes that the body releases in response to damage to the heart muscle.

Prevalence of cardiac tamponade

Cardiac tamponade is not a common disease, but it can happen to anyone. People with certain medical problems and conditions may be more susceptible to experience cardiac tamponade than normal people.

People with the following problems are more likely to get tamponade:

1. HIV

2. The end stage kidney diseases

3. History of heart failure

4. Tuberculosis

5. Lupus and some other autoimmune diseases

6. Malignant tumors

7. Chest surgeries