Cardiac tamponade - Causes and Symptoms

Definition

Cardiac tamponade occurs when an abundant pericardial effusion hinders the filling of cardiac cavities during diastole.

This condition depends on the speed with which the pericardial effusion occurs and on the compliance of the pericardium itself (within certain limits, its walls can relax and adapt to the increase in volume). A very rapid formation of liquid inside the pericardial sac, even in small quantities, can cause a cardiac compression, since the pericardium cannot stretch enough to receive it.

The most common form of cardiac tamponade is due to pericarditis (inflammation of the pericardium), therefore it can represent the complication of infections, myocardial infarction, penetrating or contusive traumas, autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis and scleroderma), neoplasms, disorders metabolic and chronic nephropathies.

In some cases, tamponades can be induced by chemotherapy, chest irradiation, drugs (eg hydralazine, isoniazid and phenytoin), cardiac surgery or other invasive procedures (eg cardiac catheterization or pacemaker insertion).

Cardiac tamponade may result from primitive cardiac tumors or metastases. The most frequent causes are represented by breast cancer, lung cancer and lymphomas. In this context, the payment preceding the tamponade condition often manifests itself suddenly and can cause chest pain or a sense of oppression that worsens in the patient supine and improves in a sitting position.

Other causes of cardiac tamponade are rupture of an aortic aneurysm, mitral stenosis and thoracic aorta dissection.

Cardiac tamponade involves symptoms similar to those of cardiogenic shock: breathing difficulties, decreased cardiac output with systemic blood pressure drop, tachycardia, angina, dizziness, sense of fainting, peripheral edema and enlargement of the liver, evident on palpation of the abdomen. The jugular veins are very dilated and protrude to the sides of the neck.

Severe cardiac tamponade is almost always accompanied by a fall of at least 10 mmHg of systolic blood pressure during inspiration (paradoxical pulse). In advanced cases, the condition can evolve towards cardiovascular collapse and can be lethal.

The condition immediately requires an echocardiography, performing a pericardiocentesis (for diagnostic and therapeutic purposes) and the patient's emergency hospitalization.