CARDIAC TAMPONADE

Life-threatening condition resulting from accumulation of pericardial fluid under pressure; impaired filling of cardiac chambers and decreased cardiac output. Accumulation of pericardial fluid raises intrapericardial pressure, hence poor ventricular filling and fall in cardiac output.

Cardiac tamponade due to disease occurs in about 2 out of 10,000 people.

CAUSES:

• Any pericarditis,
• aortic dissection,
• haemolysis,
• warfarin,
• trans-septal puncture at cardiac catheterization,
• post cardiac biopsy.

SIGNS:

• Increase Pulse
• High blood pressure
• Pulsus paradoxus
• Increase jugular vein pressure
• Kussmaul’s sign
• Muffled S₁ and S₂ ( i.e., 1^st and 2^nd heart sound)

SYMPTOMS:

• Anxiety, restlessness
• Sharp chest pain  that is felt in the neck, shoulder, back, or abdomen,
• pain that gets worse with deep breathing or coughing
• Problems breathing
• Discomfort, sometimes relieved by sitting upright or leaning forward
• Fainting, lightheadedness
• Pale, gray, or blue skin
• Palpitations
• Rapid breathing
• Swelling of the legs or abdomen

DIAGNOSIS

• ECG: Low limb lead voltage; large effusions may cause electrical alternans (alternating size of QRS complex due to swinging of heart).
• CXR: Enlarged cardiac silhouette if large (>250 mL) effusion present.
• Echocardiogram: Swinging motion of heart within large effusion; prominent respiratory alteration of RV dimension with RA and RV collapse during diastole.
• Doppler: shows marked respiratory variation of transvalvular flow velocities

MANAGEMENT:

The pericardial effusion needs urgent drainage.

Homoeopathic treatment requires a deep constitutional analysis. The history of the disease, the family medical history, physical and mental characteristics of the patient, the likes and dislikes, medication details are all taken into consideration. This approach stands in consonance with the homoeopathic convention: Well selected Homoeopathic remedies are effective for cardiac tamponade treatment.

APIS MELLIFICA:  Sudden pain just below the heart, soon extending toward right chest, with suffocation. Very feeble action of the heart; violent beats, shaking the whole body; intermittent beats. Region of heart sensitive to least pressure; rasping sounds of systole and diastole unmistakably audible. Palpitation of heart from scanty secretion of urine, heart from scanty secretion of urine, perfectly cured by establishing the natural quantity. Pulse almost imperceptible at wrist: accelerated and full; very frequent and hard; wiry; irregular and slow pulse; intermittent.

ARSENIC ALBA: Violent and insupportable throbbing of the heart, chiefly when lying on the back, and esp. at night. Irregular beatings of the heart, sometimes with anguish. Cramp in the heart. Heart-beats irritable. Palpitation with anguish, cannot lie on back; < going upstairs. Palpitation and trembling weakness after stool; must lie down. Palpitation after suppressed herpes or foot-sweat

DIGITALIS: Acceleration of the movements of the heart, with palpitations that can be heard (with slow pulse), anguish, and contraction in the sternum. Very slow pulse. On rising up in bed pulse becomes much more frequent and irregular. ─Irregular and intermittent pulse. Dull uneasiness in various parts of heart region, with sensation of weakness in forearm. Feeling of slight confusion of heart, esp. on moving, with painful sensation of weakness in wrist and forearms. Sudden sensation as though heart stood still, with great anxiety and necessity for holding breath, after dinner; must keep perfectly still.

LACHESIS: Palpitation of heart, with (fainting and) anxiety, sometimes excited by cramp-like pains, with cough, and fit of suffocation. Palpitation of heart and choking from slightest anxiety. Feels as if heart hanging by a thread and every beat would tear it off. Irregularity of beats. Constrictive sensation in region of heart. Spasms in heart (with aneurism of r. carotid) and disagreeable pulsation in ears. As if heart too large for containing cavity. Stitches in region of heart, with shortness of breath, fainting fits and cold sweat. Faint feeling about heart, with heats up spine and flushing's of face. Fainting's, giddiness, and palpitation constantly recurring.

 LYCOPODIUM: Palpitation of the heart, esp. during digestion, or in bed in evening, sometimes attended with anxiety and trembling. Accelerated pulse, with cold face and feet. Palpitation of the heart with flapping of the wings of the nose; enlargement of the heart; hypertrophy in general. Cramp and constriction, dyspnea, stitches beneath short ribs, extending to small of back and shoulders; sharp pains shooting into heart, sensation of stoppage of circulation at night, with fright and then sweat, pulse quick and unsteady.

COLCHICUM: Violent palpitation of the heart. Pressure and oppression in the region of the heart, as if an attack of apoplexy threatened; > by walking. Anxiety in region of heart. Impulse not felt. Pericarditis, with severe pain, oppression and dyspnea, pulse threadlike. Sound of heart become weaker, pulse of low tension.

SULPHUR: Sharp pain at heart goes through to between shoulders; esp. with dyspeptic symptoms. Cutting pains about heart, as with knives, which decrease or increase, last a few hours, with redness of face, followed by general coldness; attacks only when waking up. Violent congestion of blood towards chest and heart, sometimes with ebullition in chest, uneasiness, faintness, and trembling of arms. Sensation of emptiness in the cardiac region, or pressure and sensation as if the heart had not room enough. Affections in general of heart; also external chest. Sensation as if heart were enlarged. Frequent palpitation of the heart, sometimes even visible, and with anxiety; at night; in bed; on failing asleep; when going up an ascent.