Treatments

When dealing with cardiac tamponade, how do we treat and reverse the disease?

The only useful method of treatment for cardiac tamponade is to remove the pericardial fluid causing the restrictions on the heart.  We can give supportive treatments as well, such as, fluid resuscitation or inotropic agents that reduce the strength of heart contractions.

There are two ways to drain the fluid surrounding the heart,  percutaneous drainage (pericardiocentesis) or surgical drainage.

Pericardiocentesis:
Basically, a catheter is inserted into the pericardial sac through the chest wall, usually through the infrasternal angle.  Echocardiography is used during the procedure to ensure accurate insertion and to prevent puncturing a lung.

(http://www.medivisuals1.com/tamponadeandpericardiocentesis-30321602x.aspx)

Surgical drainage:

The surgeon will creates an opening in the chest wall under the sternum to visualize the pericardium. Surgical drainage has the advantages of permitting diagnostic pericardial biopsies to be taken and pericardiectomy to be performed, if needed. Direct surgical visualization may also be preferable if fluid has reaccumulated after catheter drainage, the effusion is loculated, there is a special need for biopsy material, or the patient has a coagulopathy. However, surgical drainage requires general anesthesia, which may worsen hemodynamic compromise if needle drainage is not performed first to reduce the severity of the cardiac tamponade.

(http://www.sciamsurgery.com/sciamsurgery/institutional/figTabPopup.action?bookId=ACS&linkId=part04_ch12_fig4&type=fig)

There are two reasons that pericardiocentesis cannot be performed.  Severe pulmonary hypertension can lead to a worsening of right heart function if the effusion is removed because the pressure was supporting the right ventricle. If the patient has coagulopathy, inserting a needle into their chest cavity and risking puncturing their liver can be extremely life threatening and should be avoided.  

Reference:

Holt, B. (2014, October 8). Cardiac Tamponade. Retrieved February 19, 2015, from http://www-uptodate-com.offcampus.lib.washington.edu/contents/cardiac-tamponade?source=search_result&search=cardiac tamponade&selectedTitle=1~150