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Acute Pericardial Tamponade

Life-threatening compression of the heart by pericardial fluid that impairs diastolic filling and produces obstructive shock.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Acute Pericardial Tamponade?

Acute pericardial tamponade is a clinical syndrome in which rapid accumulation of fluid, blood, pus or gas within the pericardial sac elevates intrapericardial pressure and impairs ventricular filling, producing obstructive shock.

Common causes include trauma (penetrating or blunt), aortic dissection, postcardiac surgery bleeding, malignancy (lung, breast, lymphoma), uremic pericarditis, viral or tuberculous pericarditis and complications of cardiac procedures (catheter ablation, pacemaker lead perforation).

The hallmark Beck triad consists of hypotension, jugular venous distension and muffled heart sounds; pulsus paradoxus greater than 10 mmHg is highly suggestive but not always present.

Echocardiography is the diagnostic modality of choice and demonstrates pericardial effusion with right atrial systolic collapse, right ventricular diastolic collapse, plethoric inferior vena cava and respiratory variation in tricuspid and mitral inflow.

Management requires urgent pericardiocentesis (echo-guided when possible) or pericardial window in surgical patients, intravenous fluids and inotropes as a temporizing measure, and treatment of the underlying cause.

Symptoms

Severe hypotension and shock
Jugular venous distension
Muffled or distant heart sounds
Pulsus paradoxus greater than 10 mmHg
Tachycardia and tachypnea
Cool clammy skin and altered mental status
Chest pain or fullness
Kussmaul sign in subacute presentations

Risk Factors

Recent thoracic trauma or cardiac surgery
Aortic dissection
Active malignancy with pericardial involvement
Tuberculosis or viral pericarditis
Anticoagulant therapy
Catheter ablation or pacemaker lead implantation
End-stage renal disease with uremic pericarditis

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Sudden severe shortness of breath with hypotension
  • Chest pain with neck vein distension after cardiac procedure
  • Trauma victim with hypotension unresponsive to fluids
  • Recent cardiac surgery with deteriorating hemodynamics
  • Known malignancy with worsening dyspnea and edema

Treatment Methods

01
Urgent emergency pericardiocentesis (subxiphoid or echo-guided)
02
Surgical pericardial window in surgical or recurrent cases
03
Intravenous fluid resuscitation and inotropes as bridge
04
Avoidance of positive pressure ventilation when possible until drainage
05
Pericardial fluid analysis (cytology, culture, chemistry)
06
Treatment of underlying cause (chemotherapy, antituberculous therapy, dialysis)
07
Continuous hemodynamic monitoring in intensive care unit

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.