Cardiac tamponade natural history, complications and prognosis
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[1].
Natural History and Complications
Cardiac tamponade is a life-threatening condition requiring urgent intervention to remove the fluid from the pericardial cavity. If untreated, patient may develop following complications:
- Pulmonary edema due to decreased forward flow of blood from left ventricle and increased pressures within the pulmonary vasculature.
- Cardiac failure secondary to inadequate ventricular filling and cardiac output.
- Cardiogenic shock
- Death
Prognosis
- Prognosis is good with early recognition and management of the condition and the underlying cause of the tamponade. 3.2% of 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[2] and was mostly attributed to rupture of an acute myocardial infarction or intrapericardial rupture of a dissecting ascending aortic aneurysm.
- Cardiac tamponade caused by central venous catheters had a mortality rate of 77% before 1980 and 47% between 1980-1989[3].
- Patients with underlying malignancy has the highest rate of mortality[4]. 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[1].
- 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
- ↑ 1.0 1.1 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.