Presenting Problems in Cardiovascular Disease

Cardiac tamponade vs pericardial effusion

what’s the difference between cardiac tamponade vs pericardial effusion?

Cardiac tamponade also called pericardial tamponade is a clinical syndrome that is caused by uncontrolled pericardial effusion and accumulation of fluid in pericardial space which results in medical emergency leads to shock and death. There is a major difference between cardiac tamponade vs pericardial effusion which is discussed in principle article. Cardiac tamponade causes pulmonary edema which means lung congestion during which the body struggles to get enough oxygen and start for having shortness in breath also may cause cancer, kidney failure, pericarditis, chest trauma.

Cardiac tamponade is mainly caused by myocardial rupture, accumulation of pericardial fluid, chest trauma, mainly during 24 to 48 hour of cardiac surgery there is a chance of cardiac tamponade as chest tube placed to drain blood may lead to clot formation and blood n fluids get accumulated and cause cardiac tamponade.

Pericardial effusion means the abnormal accumulation of fluid around the pericardium surrounding the heart. This accumulation of the fluid around the heart leads to an increase of Intrapericardial pressure due to limited space surrounding heart causes cardiac tamponade. So this is one of the major differences between cardiac tamponade vs pericardial effusion. It is an equilibrium that is disturbed between production and re-absorption of pericardial fluid which allows fluid to enter the pericardial cavity due to its structural abnormality

The causes of pericardial effusion are as follows

  1. Pericarditis is inflammation of pericardium with onset sharp chest pain
  2. Viral infection of an agent like coxsackievirus, echovirus, HIV, etc.
  3. Rheumatoid arthritis-it is an inflammatory autoimmune disorder that affects joints.
  4. The trichinosis-parasitic disease that is caused by roundworm in the intestine
  5. Hypothyroidism – a disorder of thyroid gland where there is less production of thyroid.
  6. Heart Surgery – Post pericardiotomy syndrome (PPS)
  7. others like kidney failure, cancer

Sign and symptoms of cardiac tamponade

The signs and symptoms between cardiac tamponade vs pericardial effusion also play an important role in understanding the differences between them. Sign and symptoms of cardiac tamponade are as follows

  • As symptoms vary with Acuteness accumulation and underlying cause of cardiac tamponade.
  • Symptoms For Acute cardiac tamponade
  • Dyspnea:- shortness of breath means air hunger.
  • Tachycardia:- faster heartbeat rate greater than 100 times per minute
  • Tachypnea:- Rapid abnormal breathe per minute i.e┬ámore than 20 breaths per minute
  • Cold and calmy extremities from hypoperfusion in some patients

Other symptoms and signs are

Other symptoms and signs of cardiac tamponade are:

  • Elevated jugular venous pressure.
  • Pulsus paradoxus – Decrease in stroke volume, systolic blood pressure, and pulse wave amplitude.
  • chest pressure – pressure or squeezing in the chest
  • The decrease in the output of urine
  • Dysphoria- accompany depression, anxiety or agitation.

Sign and symptoms of pericardial effusion

The signs and symptoms of pericardial effusion are also according to its severity and causes. The common symptoms are chest pain or chest pressure which also gets worse when we lean down or take a deeper breath. Some other symptoms are Fever, fatigue, muscle aches, shortness of breath (air hunger), and also diarrhea, nausea, vomiting when the person is affected by viruses. Some of the serious symptoms of pericardial effusion are sensation that the heartbeat gets faster. Lack of oxygen in the body causing shortness of breath that is air hunger. Here you have understood some differences between cardiac tamponade vs pericardial effusion in terms of signs and symptoms.

Diagnosis of cardiac tamponade

Diagnosis of cardiac tamponade is Mainly it has got three signs which are commonly known as Beck’s triad. They are as follows :

  1. Your blood pressure becomes low and weak pulse because of reduced pumping of heart causes low blood volume
  2. The neck of veins gets extended because it becomes hard to return blood to your heart
  3. A rapid heartbeat(Tachycardia) combines with muffled heart sounds due to the expanded layer of fluid inside pericardium

And its diagnostic tests are as follows :

  • echocardiogram which is an ultrasound of our heart
  • Thoracic CT scan confirms the accumulation of fluid in our chest and changes occur in our heart.
  • Magnetic resonance angiogram shows the flow of blood.
  • electrocardiogram to monitor heartbeat rate.

Diagnosis of pericardial effusion

The diagnosis of pericardial effusion are as cardiac tamponade, pericardial effusion does not show specific cause and symptoms so pericardial effusion is confirmed or detected after the routine testaments whose result seems to be abnormal and the main diagnostic tests are

  1. Physical examination at the hospital where the doctor detects abnormal heart sound and inflammation in the chest.
  2. Electrocardiogram (ECG)-monitors the heartbeat rate.
  3. Chest x-rays were the heart’s silhouettes seem to be larger on one side. Pericardial effusion is mainly confirmed by ultrasound of the heart (echocardiogram)

Treatment of cardiac tamponade

As cardiac tamponade is a medical emergency it needs hospitalization. The treatment between cardiac tamponade vs pericardial effusion also provides more information to know their differences.

It needs mainly two steps

Prehospital care and hospital management.

  • During pre-hospital care, these activities are carried out and its primary purpose is to first stabilize the patient.
  • It mainly manages oxygen supply
  • and monitoring the patient’s heart rate and other supportive activities.

 During hospital management the process occurs are

Firstly the doctor focuses on pericardiocentesis which means the insertion of the needle through the skin into the pericardium to release the fluid and the air in the pericardium. And followed by invasive procedures called thoracotomy to drain blood or remove blood clots if you have a penetrating wound. They may dethrone part of your pericardium to help comfort pressure on your heart. The patient will also receive oxygen, fluids, and medications to increase their blood pressure. Once the tamponade is under control and the patient’s condition stabilizes, he performs additional tests to find out the underlying cause of their condition.

Treatment of pericardial effusion

The treatment for pericardial effusion depends upon its cause and how severe the case is: Pericardial effusion which does not show symptoms and also caused by kidney failure, TB needs basic treatment in those case drugs like Motrin, Indocin, prednisone, and solumedrol, colchicine is required for patients. In severe infections or during Cardiac tamponade the fluid in the pericardial cavity is drained by two ways they are

1.pericardiocentesis which means the insertion of a needle through the skin into the pericardium to release the fluid and the air in the pericardium

2. Pericardioctomy – It is done for 3-month-old or older chronic pericardial effusion where symptoms are seen to damage our heart. For those cases, it is a process where surgical drainage also called pericardial window is made by the doctor by making an incision in the chest and cuts pericardium to drain out all the fluid. This is also risky than pericardiocentesis But it makes patients stable. This is all about the cardiac tamponade vs pericardial effusion.

Dr Aadarsh Yadav

Dr Adarsh Yadav is a registered medical expert currently is a medical officer at the department of paediatrics at Scheer memorial Adventist hospital, kavre, Nepal. He had been a very well trained medical practitioner, and apart from his medical practice, he had been a member of different health camps organizing blood donation camps in Bangladesh just during his internship.

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