Cardiac tamponade: Clinical, etiological and therapeutic features

Introduction

Cardiac tamponade is a life-threatening diagnostic and therapeutic emergency.

Objective

The aim of our study was to investigate the clinical, etiological and therapeutic characteristics of patients hospitalized for tamponade.

Method

This was a retrospective monocentric study including 40 patients admitted for tamponade to our cardiology department between January 2018 and June 2023.

Results

The mean age was of 60 ± 16 years [17,84] with a sex ratio of 2.3. The mode of onset of symptomatology was progressive in 80% of the cases. Dyspnea was constant. The main findings on physical examination were: muffled heart sounds (98%), polypnea (100%), and tachycardia (78%). Mean arterial pressure was 80 mmHg ± 15 [47,110]. Paradoxical pulse was present in 15% of cases (n = 6). Arterial hypotension was present in 28% (n = 11). Signs of right heart failure were present in 11 patients (28%). The main electrical abnormalities reported were: microvoltation (83%), atrial fibrillation (18%) and electrical alternation (30%). Transthoracic echocardiography revealed circumferential effusion in all patients. A “swinging heart” appearance was found in 30% of the cases (n = 12). All patients had signs of hemodynamic compression. Thirty-six patients (90%) were drained percutaneously. Surgical drainage was performed immediately in 4 patients and secondarily in only 1 patient whose pericardial puncture was complicated by a right ventricle wound. Neoplastic origin was the main etiology and was found in 14 patients (35%). All cases were secondary neoplasia, and the primary tumor was mainly bronchopulmonary cancer (10 cases) (Figure 1). Viral origin was the second most common etiology, found in 25% of cases. Other etiologies were iatrogenic (20%), idiopathic (7%), uremic (5%), tuberculosis (5%) and bacterial (3%). The average hospital stay was 8 ± 5 days [3,27]. The 30-day mortality rate was 12%. Two patients (5%) had a recurrent event: the first case was a neoplasic tamponade and the second was a viral tamponade. No cases of transition to constriction were reported.

Conclusion

Tamponade is a serious pathology requiring urgent and effective management. Prognosis depends on the quality of therapeutic management and the nature of the causative pathology.