Cardiac tamponade natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ;Associate Editor(s)-in-Chief: Ramyar Ghandriz MD[2]
Overview
Cardiac tamponade is a life-threatening condition requiring urgent intervention to remove the pericardial fluid. Complications include pulmonary edema, cardiac failure, cardiogenic shock and ultimately death.
Cardiac tamponade has a good prognosis if detected early and treated immediately. Short-term survival is mostly dependent on early diagnosis and relief of tamponade. Long-term survival depends upon the prognosis of the underlying cause, irrespective of the mode of treatment.
Natural History, Complications, and Prognosis
Natural History
- Because of restrictive manners of cardiac tamponade , it causes acute heart failure and increase in blood hydro-static pressure.[1]
- In severe forms, increase in hydro-static pressure and decompensated left and right heart failure causes pulmonary edema, low blood pressure,low brain blood supply and eventually death.
Complications
Cardiac tamponade is a life-threatening condition requiring urgent intervention to remove the fluid from the pericardial cavity. If untreated, the patient may develop the following complications[2]:
- Pulmonary edema due to decreased forward flow of blood from the left ventricle and increased pressures within the pulmonary vasculature.
- Cardiac failure secondary to inadequate ventricular filling and cardiac output.
- Cardiogenic shock
- Pulseless electrical activity
- Death
Complications
Prognosis
- The prognosis of cardiac tamponade depends upon tow factors:
- The underlying condition
- duration of diagnosis and treatment
- The prognosis of a cardiac tamponade is typically good with early recognition and management of the condition and the underlying causes of the tamponade. 3.2% of the total deaths over a 10-year period were attributable to cardiac tamponade in a postmortem study of 14,368 patients in County of Cornwall, UK between 1995 and 2004.[3]
- Cardiac tamponade caused by central venous catheters had a mortality rate of 77% before 1980 and 47% between 1980-1989[4].
- Patients with underlying malignancy has the highest rate of mortality[5]. Short-term survival is mostly dependent on early diagnosis and relief of tamponade. Long-term survival depends upon the prognosis of the underlying cause, irrespective of the mode of treatment[2].
- Tamponade secondary to idiopathic effusion and penetrating chest wounds has been shown to be associated with better outcomes with emergent removal of pericardial fluid.
References
- ↑ Weitzman, L B; Tinker, W P; Kronzon, I; Cohen, M L; Glassman, E; Spencer, F C (1984). "The incidence and natural history of pericardial effusion after cardiac surgery--an echocardiographic study". Circulation. 69 (3): 506–511. doi:10.1161/01.CIR.69.3.506. ISSN 0009-7322.
- ↑ 2.0 2.1 Markiewicz W, Borovik R, Ecker S (1986). "Cardiac tamponade in medical patients: treatment and prognosis in the echocardiographic era". Am Heart J. 111 (6): 1138–42. PMID 3716989.
- ↑ Swaminathan A, Kandaswamy K, Powari M, Mathew J (2007). "Dying from cardiac tamponade". World J Emerg Surg. 2: 22. doi:10.1186/1749-7922-2-22. PMC 2042492. PMID 17822563.
- ↑ Nasim A, Cooper GG, Ah-See AK (1992). "Cardiac tamponade due to central venous catheterization". J R Coll Surg Edinb. 37 (5): 337–9. PMID 1282555.
- ↑ Soler-Soler J, Sagristà-Sauleda J, Permanyer-Miralda G (2001). "Management of pericardial effusion". Heart. 86 (2): 235–40. PMC 1729838. PMID 11454853.