Editing Cardiac tamponade

{{Short description|Buildup of fluid around the heart}}
{{Infobox medical condition (new)
| name            = Cardiac tamponade
| synonyms        = Pericardial tamponade
| image           = Hemorragic effusion.jpg
| caption         = A very large [[pericardial effusion]] resulting in tamponade as a result of bleeding from [[cancer]] as seen on ultrasound. Closed arrow – the heart; open arrow – the effusion
| field           = [[Cardiac surgery]]
| symptoms        = [[Shortness of breath]], weakness, [[lightheadedness]], cough<ref name=Spod2003/>
| complications   =
| onset           = Rapid or more gradual<ref name=Ri2014/>
| duration        =
| types           =
| causes          = [[Cancer]], [[kidney failure]], [[chest trauma]], [[pericarditis]], [[tuberculosis]]<ref name=Ri2014/><ref name=Spod2003/>
| risks           =
| diagnosis       = Symptoms and [[echocardiogram|ultrasound of the heart]]<ref name=Ri2014/>
| differential    =
| prevention      =
| treatment       = Drainage ([[pericardiocentesis]], [[pericardial window]], [[pericardiectomy]])<ref name=Ri2014/>
| medication      =
| prognosis       =
| frequency       = 2 per 10,000 per year (US)<ref name=Kah2008/>
| deaths          =
}}
<!-- Definition and symptoms -->
'''Cardiac tamponade''', also known as '''pericardial tamponade''' ({{IPAc-en|ˌ|t|æ|m|.|p|ə|ˈ|n|eɪ|d}}<ref>{{cite web|url=https://www.lexico.com/definition/tamponade |archive-url=https://web.archive.org/web/20210304040040/https://www.lexico.com/definition/tamponade |url-status=dead |archive-date=March 4, 2021 |title=Tamponade &#124; Meaning & Definition for UK English |publisher=Lexico.com |date= |accessdate=2022-08-24}}</ref>), is a compression of the [[heart]] due to [[pericardial effusion]] (the build-up of [[pericardial fluid]] in the [[pericardium|sac around the heart]]).<ref name=Ri2014>{{cite journal|last1=Richardson|first1=L|title=Cardiac tamponade.|journal= Journal of the American Academy of Physician Assistants|date=November 2014|volume=27|issue=11|pages=50–51|pmid=25343435|doi=10.1097/01.jaa.0000455653.42543.8a|s2cid=205395461}}</ref> Onset may be rapid or gradual.<ref name=Ri2014/> Symptoms typically include those of [[obstructive shock]] including [[shortness of breath]], weakness, [[lightheadedness]], and cough.<ref name=Spod2003/> Other symptoms may relate to the underlying cause.<ref name=Spod2003/>

<!-- Cause -->
Common causes of cardiac tamponade include [[cancer]], [[kidney failure]], [[chest trauma]], [[myocardial infarction]], and [[pericarditis]].<ref name=Ri2014/><ref name=Mer2020>{{cite web |title=Cardiac Tamponade – Injuries and Poisoning |url=https://www.merckmanuals.com/home/injuries-and-poisoning/chest-injuries/cardiac-tamponade |website=Merck Manuals Consumer Version |access-date=1 May 2020}}</ref> Other causes include [[connective tissue disease|connective tissues diseases]], [[hypothyroidism]], [[aortic rupture]], [[autoimmune disease]], and complications of [[cardiac surgery]].<ref name=Ri2014/><ref>{{cite journal|last1=Schiavone|first1=WA|title=Cardiac tamponade: 12 pearls in diagnosis and management.|journal=Cleveland Clinic Journal of Medicine|date=February 2013|volume=80|issue=2|pages=109–116|pmid=23376916|doi=10.3949/ccjm.80a.12052|doi-access=free}}</ref> In Africa, [[tuberculosis]] is a relatively common cause.<ref name=Spod2003>{{cite journal|last1=Spodick|first1=DH|title=Acute cardiac tamponade.|journal=The New England Journal of Medicine|date=Aug 14, 2003|volume=349|issue=7|pages=684–690|pmid=12917306|doi=10.1056/NEJMra022643}}</ref>

<!-- Diagnosis and mechanism -->
Diagnosis may be suspected based on [[hypotension|low blood pressure]], [[jugular venous distension]], or quiet [[heart sounds]] (together known as [[Beck's triad (cardiology)|Beck's triad]]).<ref name=Ri2014/><ref name=Spod2003/><ref>{{cite journal |last1=Khandaker |first1=MH |last2=Espinosa |first2=RE |last3=Nishimura |first3=RA |last4=Sinak |first4=LJ |last5=Hayes |first5=SN |last6=Melduni |first6=RM |last7=Oh |first7=JK |title=Pericardial disease: diagnosis and management. |journal=Mayo Clinic Proceedings |date=June 2010 |volume=85 |issue=6 |pages=572–593 |doi=10.4065/mcp.2010.0046 |pmid=20511488|pmc=2878263 }}</ref> A [[pericardial rub]] may be present in cases due to inflammation.<ref name=Ri2014/> The diagnosis may be further supported by specific [[electrocardiogram]] (ECG) changes, [[chest X-ray]], or an [[echocardiogram|ultrasound of the heart]].<ref name=Ri2014/> If fluid increases slowly the pericardial sac can expand to contain more than 2 liters; however, if the increase is rapid, as little as 200 mL can result in tamponade.<ref name=Ri2014/>

<!-- Treatment and epidemiology -->
Tamponade is a medical emergency.<ref name=Mer2020/> When it results in symptoms, drainage is necessary.<ref name=Sa2011/> This can be done by [[pericardiocentesis]], surgery to create a [[pericardial window]], or a [[pericardiectomy]].<ref name=Ri2014/> Drainage may also be necessary to rule out infection or cancer.<ref name=Sa2011>{{cite journal|last1=Sagristà-Sauleda|first1=J|last2=Mercé|first2=AS|last3=Soler-Soler|first3=J|title=Diagnosis and management of pericardial effusion.|journal=World Journal of Cardiology|date=26 May 2011|volume=3|issue=5|pages=135–143|pmid=21666814|doi=10.4330/wjc.v3.i5.135|pmc=3110902|doi-access=free}}</ref> Other treatments may include the use of [[dobutamine]] or in those with [[hypovolemia|low blood volume]], [[intravenous fluids]].<ref name=Spod2003/> Those with few symptoms and no worrisome features can often be closely followed.<ref name=Ri2014/> The frequency of tamponade is unclear.<ref name=Bod2011>{{cite journal|last1=Bodson|first1=L|last2=Bouferrache|first2=K|last3=Vieillard-Baron|first3=A|title=Cardiac tamponade.|journal=Current Opinion in Critical Care|date=October 2011|volume=17|issue=5|pages=416–424|pmid=21716107|doi=10.1097/mcc.0b013e3283491f27|s2cid=25236604}}</ref> One estimate from the United States places it at 2 per 10,000 per year.<ref name=Kah2008>{{cite book|last1=Kahan|first1=Scott|title=In a Page: Medicine|date=2008|publisher=Lippincott Williams & Wilkins|isbn=9780781770354|page=20|url=https://books.google.com/books?id=46wpAUhUHjMC&pg=PA20|language=en|url-status=live|archive-url=https://web.archive.org/web/20161002084949/https://books.google.ca/books?id=46wpAUhUHjMC&pg=PA20|archive-date=2016-10-02}}</ref>

==Signs and symptoms==
Onset may be rapid (acute) or more gradual (subacute).<ref name=":0">{{Citation|last1=Stashko|first1=Eric|title=Cardiac Tamponade|date=2019|url=http://www.ncbi.nlm.nih.gov/books/NBK431090/|work=StatPearls|publisher=StatPearls Publishing|pmid=28613742|access-date=2019-08-02|last2=Meer|first2=Jehangir M.}}</ref><ref name=Ri2014/> Signs of cardiac tamponade typically include those of [[cardiogenic shock]] including [[shortness of breath]], weakness, [[lightheadedness]], cough<ref name=Spod2003/> and those of [[Beck's triad (cardiology)|Beck's triad]] e.g. jugular vein distention, quiet heart sounds and [[hypotension]]. Other symptoms may relate to the underlying cause.<ref name=Spod2003/>

Other general signs of shock (such as [[tachycardia|fast heart rate]], [[Dyspnea|shortness of breath]] and decreasing [[Glasgow coma scale|level of consciousness]]) may also occur. However, some of these signs may not be present in certain cases. A fast heart rate, although expected, may be absent in people with [[uremia]] and [[hypothyroidism]].<ref name="Spod2003" />

According to Reddy and co-authors, cardiac tamponade and its progression can be described in 3 different phases.<ref name=":2">Reddy PS, Curtiss EI, Uretsky BF. Spectrum of hemodynamic changes in cardiac tamponade. Am J Cardiol. 1990 Dec 15;66(20):1487-91. {{doi|10.1016/0002-9149(90)90540-h}}. {{PMID|2251997}}.</ref> In phase I, the required filling pressure increases due to the high stiffness of the ventricles. This is because of the accumulation of pericardial fluid in the pericardial cavity. During phase II, the pericardial pressure exceeds the ventricular filling pressure caused by the further accumulation of pericardial fluid. This results in a decrease in cardiac input and output. A further decrease of cardiac input and output is typical in phase III of the progression of cardiac tamponade. This is caused by the equilibration of left ventricular filling and pericardial pressure, leading to “severe deterioration of end-organ perfusion.”<ref name=":2" /> Some of the symptoms, as a consequence, include abdominal pain due to liver engorgement.

==Causes==
Cardiac tamponade is caused by a large or uncontrolled [[pericardial effusion]], i.e. the buildup of fluid inside the pericardium.<ref name=Mattson>{{cite book |author1=Porth, Carol |author2=Carol Mattson Porth |title=Pathophysiology: concepts of altered health states |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2005 |isbn=978-0-7817-4988-6 |edition=7th }}</ref> This commonly occurs as a result of [[Chest injury|chest trauma]] (both blunt and penetrating),<ref name=Gwinnutt>{{cite book |vauthors=Gwinnutt CL, Driscoll PA |title=Trauma Resuscitation: The Team Approach |location=Oxford |publisher=BIOS |edition=2nd |year=2003 |isbn=978-1-85996-009-7 }}</ref> but can also be caused by [[myocardial infarction]], [[myocardial rupture]], [[cancer]] (most often [[Hodgkin lymphoma]]), [[uremia]], [[pericarditis]], or cardiac surgery,<ref name=Mattson/> and rarely occurs during retrograde [[aortic dissection]],<ref>{{cite journal |vauthors=Isselbacher EM, Cigarroa JE, Eagle KA |title=Cardiac tamponade complicating proximal (retrograde) aortic dissection. Is pericardiocentesis harmful? |journal=Circulation |volume=90 |issue=5 |pages=2375–2378 |date=Nov 1994 |pmid=7955196 |doi= 10.1161/01.CIR.90.5.2375|doi-access=free }}</ref> or while the person is taking anticoagulant therapy.<ref name=Longmore>{{cite book |author1=Longmore, J. M. |author2=Murray Longmore |author3=Wilkinson, Ian |author4=Supraj R. Rajagopalan |title=Oxford handbook of clinical medicine |publisher=Oxford University Press |location=Oxford [Oxfordshire] |year=2004 |isbn=978-0-19-852558-5 |edition=6th }}</ref> The effusion can occur rapidly (as in the case of trauma or myocardial rupture), or over a more gradual period of time (as in cancer). The fluid involved is often [[blood]], but [[pus]] is also found in some circumstances.<ref name=Mattson/>

===Surgery===

One of the most common settings for cardiac tamponade is in the first 7 days after heart surgery.<ref>{{cite journal | last1=Carmona | first1=Paula | last2=Mateo | first2=Eva | last3=Casanovas | first3=Irene | last4=Peña | first4=Juan J. | last5=Llagunes | first5=Jose | last6=Aguar | first6=Federico | last7=De Andrés | first7=Jose | last8=Errando | first8=Carlos | title=Management of Cardiac Tamponade After Cardiac Surgery | journal=Journal of Cardiothoracic and Vascular Anesthesia | publisher=Elsevier BV | volume=26 | issue=2 | year=2012 | issn=1053-0770 | doi=10.1053/j.jvca.2011.06.007 | pages=302–311| pmid=21868250 }}</ref>  After heart surgery, [[chest tube]]s are placed to drain blood.  These chest tubes, however, are prone to clot formation.  When a chest tube becomes occluded or clogged, the blood that should be drained can accumulate around the heart, leading to tamponade.<ref>{{cite journal | last1=Vistarini | first1=Nicola | last2=Gabrysz-Forget | first2=Fanny | last3=Beaulieu | first3=Yanick | last4=Perrault | first4=Louis P. | title=Tamponade Relief by Active Clearance of Chest Tubes | journal=The Annals of Thoracic Surgery | publisher=Elsevier BV | volume=101 | issue=3 | year=2016 | issn=0003-4975 | doi=10.1016/j.athoracsur.2015.10.098 | pages=1159–1163| pmid=26897195 | doi-access=free }}</ref>

==Pathophysiology==
[[File:Blausen 0164 CardiacTamponade 02.png|thumb|250px|[[Hemopericardium]], wherein the [[pericardium]] becomes filled with [[blood]], is one cause of cardiac tamponade.]]
The pericardium, the double-walled sac surrounding the heart, consists of a fibrous pericardium layer on the outside and a double-layered serous pericardium on the inside.<ref>{{cite journal |last1=Sharma |first1=Nitish K. |last2=Waymack |first2=James R. |title=Acute Cardiac Tamponade |journal=StatPearls |date=4 August 2021 |pmid=30521227 |url=https://www.ncbi.nlm.nih.gov/books/NBK534806/ |access-date=22 November 2021}}</ref> Between the two layers of the serous pericardium is the pericardial space, which is filled with lubricating serous fluid that prevents friction as the heart contracts.<ref>{{cite journal |last1=Vogiatzidis |first1=Konstantinos |last2=Zarogiannis |first2=Sotirios G. |last3=Aidonidis |first3=Isaac |last4=Solenov |first4=Evgeniy I. |last5=Molyvdas |first5=Paschalis-Adam |last6=Gourgoulianis |first6=Konstantinos |last7=Hatzoglou |first7=Chrissi |title=Physiology of pericardial fluid production and drainage |journal=Frontiers in Physiology |date=18 March 2015 |volume=6 |page=62 |doi=10.3389/fphys.2015.00062 |pmid=25852564 |pmc=4364155 |doi-access=free }}</ref> The outer layer of the heart is made of fibrous tissue<ref name=Thibodeau>{{cite book |vauthors=Patton KT, Thibodeau GA |title=Anatomy & physiology |publisher=Mosby |location=St. Louis |year=2003 |isbn=978-0-323-01628-5 |edition=5th }}</ref> which does not easily stretch, so once excess fluid begins to enter the pericardial space, pressure starts to increase.<ref name=Mattson/> Consequently, the heart becomes compressed due to its inability to fully relax.<ref name=":1">{{Citation|last1=Stashko|first1=Eric|title=Cardiac Tamponade|date=2021|url=http://www.ncbi.nlm.nih.gov/books/NBK431090/|work=StatPearls|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=28613742|access-date=2021-11-24|last2=Meer|first2=Jehangir M.}}</ref>

If fluid continues to accumulate, each successive diastolic period leads to less blood entering the ventricles. Eventually, increasing pressure on the heart forces the [[interventricular septum|septum]] to bend in towards the [[left ventricle]], leading to a decrease in [[stroke volume]].<ref name=Mattson/> This causes the development of [[obstructive shock]], which if left untreated may lead to [[cardiac arrest]] (often presenting as [[pulseless electrical activity]]).<ref>{{cite journal | last1=Standl | first1=Thomas | last2=Annecke | first2=Thorsten | last3=Cascorbi | first3=Ingolf | last4=Heller | first4=Axel R. | last5=Sabashnikov | first5=Anton | last6=Teske | first6=Wolfram | title=The Nomenclature, Definition and Distinction of Types of Shock | journal=Deutsches Ärzteblatt International | volume=115 | issue=45 | date=2019-02-03 | pages=757–768 | pmid=30573009 | doi=10.3238/arztebl.2018.0757 | pmc=6323133 }}</ref> The decrease in stroke volume can also ultimately lead to a decrease in cardiac output, which could be signaled by tachycardia and hypotension.<ref name=":1" />

== Diagnosis ==
[[File:Uotw78.webm|thumb|left|upright=1.3|An ultrasound of the heart showing cardiac tamponade.<ref name=UOTW78>{{cite web|last1=Smith|first1=Ben|title=UOTW#78 - Ultrasound of the Week|url=https://www.ultrasoundoftheweek.com/uotw-78/|website=Ultrasound of the Week|access-date=13 March 2017|date=27 February 2017|url-status=live|archive-url=https://web.archive.org/web/20170313124516/https://www.ultrasoundoftheweek.com/uotw-78/|archive-date=13 March 2017}}</ref>]]

The three classic signs, known as [[Beck's triad (cardiology)|Beck's triad]], are [[Hypotension|low blood pressure]], jugular-venous distension, and muffled [[heart sounds]].<ref name="Dolan">{{cite book|title=Accident and emergency: theory into practice|vauthors=Holt L, Dolan B|publisher=Baillière Tindall|year=2000|isbn=978-0-7020-2239-5|location=London}}</ref> Other signs may include [[pulsus paradoxus]] (a drop of at least 10 mmHg in arterial blood pressure with inspiration),<ref name="Mattson" /> and [[ST segment]] changes on the [[electrocardiogram]],<ref name="Dolan" /> which may also show low voltage [[QRS complex]]es.<ref name="Longmore" />

===Medical imaging===
Tamponade can often be diagnosed radiographically. [[Echocardiography]], which is the diagnostic test of choice, often demonstrates an enlarged pericardium or collapsed ventricles. A large cardiac tamponade will show as an enlarged globular-shaped heart on chest x-ray. During inspiration, the negative pressure in the [[thoracic cavity]] will cause increased pressure into the right ventricle.  This increased pressure in the right ventricle will cause the interventricular septum to bulge towards the left ventricle, leading to decreased filling of the left ventricle. At the same time, right ventricle volume is markedly diminished and sometimes it can collapse.<ref name=Longmore/>

{{gallery
|width=220
|File:Uotw78b (convert-video-online.com).webm|Apical ultrasound image of the heart in a person with cardiac tamponade. Note how the right atrial collapses during systole.<ref name=UOTW78/>
|File:UltrasoundCardiacTamponade.webm|Ultrasound image of the [[inferior vena cava]] (IVC) in a person with cardiac tamponade. Note that the IVC is large and changes minimally with breathing.<ref name=UOTW78/>
}}

===Differential diagnosis===
Initial diagnosis of cardiac tamponade can be challenging, as there is a broad [[differential diagnosis]].<ref name=":0" /> The differential includes possible diagnoses based on symptoms, time course, mechanism of injury, patient history. Rapid onset cardiac tamponade may also appear similar to pleural effusions, [[obstructive shock]], shock, pulmonary embolism, and [[tension pneumothorax]].<ref name=Gwinnutt/><ref name=":0" />

If symptoms appeared more gradually, the differential diagnosis includes acute [[Heart failure with preserved ejection fraction|heart failure]].<ref>{{Citation|last1=Chahine|first1=Johnny|title=Left Ventricular Failure|date=2019|url=http://www.ncbi.nlm.nih.gov/books/NBK537098/|work=StatPearls|publisher=StatPearls Publishing|pmid=30725783|access-date=2019-08-02|last2=Alvey|first2=Heidi}}</ref>

In a person with trauma presenting with [[pulseless electrical activity]] in the absence of hypovolemia and tension pneumothorax, the most likely diagnosis is cardiac tamponade.<ref name="ACS">American College of Surgeons Committee on Trauma (2007). ''Advanced Trauma Life Support for Doctors, 7th Edition''. Chicago: American College of Surgeons</ref>

In addition to the diagnostic complications afforded by the wide-ranging differential diagnosis for chest pain, diagnosis can be additionally complicated by the fact that people will often be weak or faint at presentation. For instance, a fast rate of breathing and difficulty breathing on exertion that progresses to air hunger at rest can be a key diagnostic symptom, but it may not be possible to obtain such information from people who are unconscious or who have convulsions at presentation.<ref name=Spod2003 />

==Treatment==

===Pre-hospital care===
Initial treatment given will usually be supportive in nature, for example administration of [[oxygen]], and monitoring. There is little care that can be provided pre-hospital other than general treatment for shock. Some teams have performed an emergency [[thoracotomy]] to release clotting in the [[pericardium]] caused by a penetrating chest injury.{{citation needed|date=July 2020}}

Prompt diagnosis and treatment is the key to survival with tamponade.  Some pre-hospital providers will have facilities to provide [[pericardiocentesis]], which can be life-saving.  If the person has already suffered a [[cardiac arrest]], pericardiocentesis alone cannot ensure survival, and so rapid evacuation to a hospital is usually the more appropriate course of action.{{Citation needed|date=August 2019}}

===Hospital management===
Initial management in hospital is by pericardiocentesis.<ref name=Gwinnutt/> This involves the insertion of a needle through the skin and into the pericardium and aspirating fluid under ultrasound guidance preferably. This can be done laterally through the intercostal spaces, usually the fifth, or as a subxiphoid approach.<ref>{{cite web |url=http://emedicine.medscape.com/article/80602-overview |title=Pericardiocentesis |author=Shlamovitz, Gil |date=4 August 2011 |website=Medscape |access-date=16 August 2011 |url-status=live |archive-url=https://web.archive.org/web/20110823232231/http://emedicine.medscape.com/article/80602-overview |archive-date=23 August 2011 }}</ref><ref>{{cite web |url=http://emedicine.medscape.com/article/152083-treatment |title=Cardiac Tamponade Treatment & Management |author=Yarlagadda, Chakri |date=11 August 2011 |website=Medscape |access-date=16 August 2011 |url-status=live |archive-url=https://web.archive.org/web/20110816134044/http://emedicine.medscape.com/article/152083-treatment |archive-date=16 August 2011 }}</ref> A left parasternal approach begins 3 to 5&nbsp;cm left of the sternum to avoid the left internal mammary artery, in the 5th [[intercostal space]].<ref>Synovitz C.K., Brown E.J. (2011). Chapter 37. Pericardiocentesis. In Tintinalli J.E., Stapczynski J, Ma O, Cline D.M., Cydulka R.K., Meckler G.D., T (Eds), ''Tintinalli's Emergency Medicine: A Comprehensive Study Guide'', 7e. Retrieved September 19, 2014 from {{Cite book |chapter-url=http://accessmedicine.mhmedical.com/content.aspx?bookid=348&Sectionid=40381499 |title=Archived copy |access-date=2014-09-20 |url-status=live |archive-url=https://web.archive.org/web/20160304045123/http://accessmedicine.mhmedical.com/content.aspx?bookid=348&Sectionid=40381499 |archive-date=2016-03-04 |chapter=Chapter 37. Pericardiocentesis |publisher=The McGraw-Hill Companies |year=2011 }}</ref> Often, a [[cannula]] is left in place during resuscitation following initial drainage so that the procedure can be performed again if the need arises. If facilities are available, an emergency [[pericardial window]] may be performed instead,<ref name=Gwinnutt/> during which the pericardium is cut open to allow fluid to drain. Following stabilization of the person, surgery is provided to seal the source of the bleed and mend the pericardium.{{citation needed|date=January 2021}}

Following heart surgery, the amount of chest tube drainage is monitored.  If the drainage volume drops off, and the blood pressure goes down, this can suggest a tamponade due to chest tube clogging.  In that case, the person is taken back to the operating room for an emergency reoperation.{{citation needed|date=January 2021}}

If aggressive treatment is offered immediately and no complications arise (shock, AMI or arrhythmia, heart failure, aneurysm, carditis, embolism, or rupture), or they are dealt with quickly and fully contained, then adequate survival is still a distinct possibility.{{Citation needed|date=August 2019}}

==Epidemiology==
The frequency of tamponade is unclear.<ref name=Bod2011/> One estimate from the United States places it at 2 per 10,000 per year.<ref name=Kah2008/> It is estimated to occur in 2% of those with stab or gunshot wounds to the chest.<ref>{{cite book|last1=Marx|first1=John|last2=Walls|first2=Ron|last3=Hockberger|first3=Robert|title=Rosen's Emergency Medicine - Concepts and Clinical Practice|date=2013|publisher=Elsevier Health Sciences|isbn=978-1455749874|page=448|url=https://books.google.com/books?id=uggC0i_jXAsC&pg=PA448|language=en|url-status=live|archive-url=https://web.archive.org/web/20161002084510/https://books.google.ca/books?id=uggC0i_jXAsC&pg=PA448|archive-date=2016-10-02}}</ref>

==References==
{{Reflist}}

== External links ==
{{Medical resources
| DiseasesDB      =
| ICD10           = {{ICD10|I|31|9|i|30}}
| ICD9            = {{ICD9|423.3}}
| ICDO            =
| OMIM            =
| MedlinePlus     = 000194
| eMedicineSubj   = med
| eMedicineTopic  = 283
| eMedicine_mult  = {{eMedicine2|emerg|412}}
| MeshID          = D002305
| ICD10CM         = {{ICD10CM|I31.4}}
}}
{{Circulatory system pathology}}
{{chest trauma}}
{{Trauma |state=autocollapse}}

[[Category:Chest trauma]]
[[Category:Pericardial disorders]]
[[Category:Disorders of fascia]]
[[Category:Heart diseases]]
[[Category:Medical emergencies]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Wikipedia emergency medicine articles ready to translate]]