What is Pericardial Tamponade?

Pericardial tamponade is an emergency medical condition in which fluid buildup in the heart reduces the organ's ability to expand and pump blood. The condition usually causes extreme, sudden chest pain and breathing difficulties that can ultimately lead to fainting. Emergency room doctors can conduct a series of delicate procedures to remove excess fluid from the heart and prompt it to start pumping again. Without immediate treatment, however, pericardial tamponade is usually fatal.

The pericardium is the fibrous sac that surrounds and protects the heart. It is made up of two layers, a tough outer layer and an inner mucous membrane that secretes pericardial fluid. In normal amounts, the fluid helps to cushion the heart and reduce friction. When too much fluid is released, however, heart ventricles become compressed and cannot effectively pump blood throughout the body. Fluid accumulation can be a result of a bacterial or viral infection, a blood clot, a cancerous tumor, or direct trauma to the chest.

Pericardial tamponade occurs quickly and progresses through three phases. The ventricles can still pump blood in the first phase, but an individual may begin to notice chest pain and tightness. Phase two involves a sharp drop in cardiac output, leading to severe anxiety, difficulty breathing, and heart palpitations. The final phase results in almost no cardiac output, which can cause a person to lose consciousness, turn pale, and stop breathing. Emergency care is needed to quickly identify pericardial tamponade and begin treatment to stabilize the heart.

In the emergency room, doctors can administer oxygen and intravenous fluids to prevent heart failure. Once vital signs are stable, specialists may decide to take an echocardiogram or chest x-ray to confirm excess pericardial fluid in the heart. Doctors usually decide to drain the fluid by inserting a long needle directly into the heart and drawing the fluid out with suction. If the heart does not resume normal functioning after fluid drainage, surgeons may need to conduct an open-heart procedure to manually expand the space between the two layers of pericardium. When treatment is administered immediately, most patients are able to survive pericardial tamponade.

Patients are generally kept in the hospital for several days following treatment, so specialists can monitor their conditions and identify the underlying causes of their heart problems. Additional surgeries or medications may be needed to prevent future complications. Patients who remain stable are released and instructed to make healthy lifestyle changes, such as quitting smoking and maintaining a low-cholesterol diet.