Clinical Profile and Outcomes of Adult Patients with Echocardiographic Evidence of Cardiac Tamponade at the Philippine General Hospital: A 5-year Study (The CAPTIVE- Heart Study)

Kristine D. Tumabiene, Lowe L. Chiong, Leora Flor P. Macapugay,
Melgar O. Matulac and Felix Eduardo R. Punzalan

Section of Cardiology, Department of Medicine, College of Medicine and
Philippine General Hospital, University of the Philippines Manila

Background. Cardiac tamponade is a life-threatening hemodynamic condition from pericardial effusions that increase intrapercardial  pressure suffeciently to externally compress and restrict cardiac chamber filling, contrain cardiac output, and induce backward failure. The number of pericardial effusions arising from cardiothoracic post-surgical and catheter-based procedures accounts for 70% of all the cases in one series. In the Philippines, tuberculous infection remains as one of the most common etiologies of percarditis, and accounts for 25.1% of the 438 cases of pericardial effusion in a local review.

Methods. This is a retrospective cross-sectional study. The inpatient adult echocardiograhy database of the Philippine General Hospital-Section of Cardiology from June 2007 to June 2012 ws reviewed, and all confirmed studies with evidence of cardiac tamponade on echocardiography were included.

Results. A total of 58 patients were included in this review. The age ranged from 18-75 years. with mean of 43 +/- 15 years. Thirty-eigth (66%) patients were diagnosed cases of malignancy, with lung cancer as the most common type. The other concomitant conditions included pulmonary tuberculosis (12%), presense of pulmonary mass of undetermined etiology (7%), systemic lupus
erythematosus (3%), endocrine disorder (3%), renal failure (3%), and post cardiac surgery status (2%). The most common clinical findings were tachycardia (84%) and elevated jugular venous pressure (57%). Hemodynamic compromise was seen in 8 patients (14%), and Beck's triad was present in only 5 (9%) of the cases. The pericardial effusions were moderate to large in size in 95% of the cases. All effusions were circumferencial, and 100% had right-sided chamber collapse, 38 (66%) of which had both right atrial and right ventricular diastolic collapse.

Conclusions. Malignancy and TB pericarditis account for most cases of cardiac tamponade in our setting. There should be a high index of suspicion for cardiac tamponade among patients presenting with difficulty of breathing and tachycardia, espcially on a background of malignancy of TB infection. Cardiac tamponade carries a high in-hospital mortality rate and prompt recognition and intervention is warranted. There was a higher rate of intervention among those who survived their hospitalization, a finding that is similarly reflected by a previous study.

Keywords: cardiac tamponade, pericardial effusion, malignancy, TB pericarditis, Philippines