Cardiac tamponade natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ;Associate Editor(s)-in-Chief: Ramyar Ghandriz MD[2]

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.

• 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.

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

• The prognosis of cardiac tamponade depends upon tow factors:

1. The underlying condition
2. 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.

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