Whatis this condition?
In cardiac tamponade, blood enters the sac around the heart (called the pericardial sac) and puts pressure on the heart muscle, impairing heart function. A slow accumulation and rise in pressure may not produce immediate symptoms because the pericardial sac can gradually stretch to accommodate the increase in fluid. However, if fluid builds up rapidly, tamponade may be fatal.
What causes it?
Cardiac tamponade may be idiopathic or may result from:
. cancer, bacterial infections, tuberculosis and, rarely, acute rheumatic fever.
. hemorrhage from trauma (such as gunshot or stab wounds of the chest) or nontraumatic causes (such as rupture of the heart or great vessels)
. heart attack
. uremia (an excess of waste products in the blood produced by the metabolism of protein).
What are its symptoms?
Cardiac tamponade causes increased pressure in the veins (a persons neck veins become visibly distended), low blood pressure, muffled heart sounds, and pulsus paradoxus (a pulse that decreases during inspiration). The disorder may also cause pallor or bluish discoloration of the skin, anxiety, rapid heart rate, restlessness, and liver enlargement. The person typically sits upright and leans forward during the episode of tamponade.
How is it diagnosed?
A chest X-ray, an electrocardiogram, pulmonary artery catheterization, and an ultrasound test of the heart identify the effects of cardiac tamponade.
How is it treated?
The goal of treatment is to relieve pressure around the heart by removing accumulated blood or fluid. This may be achieved by a procedure called pericardiocentesis (needle aspiration of the pericardial cavity) or surgical creation of an opening in the pericardial sac (called a pericardial window).
The persons cardiac output (the amount of blood pumped out of the heart each minute) will be maintained with intravenous fluids, albumin, and an inotropic drug, such as Isuprel or Intropin.
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