A 26-year-old teacher named Giulia Silva de Araújo died of cardiac tamponade last Wednesday, September 2, in Rio de Janeiro state, after being discharged from medical care twice in a row following a diagnosis of anxiety.
CNN Brasil spoke with specialists who explained that palpitations and shortness of breath are common symptoms of both anxiety and cardiac tamponade, and because the heart condition is rare and not widely known, the two can easily be confused.
What is cardiac tamponade
Cardiac tamponade is a serious condition caused by a buildup of fluid or blood in the pericardium, the membrane that surrounds the heart. The pressure this places on the organ prevents it from pumping blood properly.
Cardiologist Vagner Vinícius said the fluid buildup in that space raises the pressure on the heart and makes it harder for the organ to fill and pump blood adequately. He said that, depending on how quickly this happens, it can become a life-threatening emergency.
What causes it
Tamponade is not necessarily a disease on its own. It is usually a complication of other conditions that cause fluid or blood to build up in the space around the heart, including autoimmune diseases, infections, cancer and certain conditions linked to fluid retention. The typical patient profile therefore varies depending on the underlying illness causing the pericardial effusion.
Ronaldo Gismondi, a cardiologist and medical director at Afya Educação Médica, said that besides health problems, physical trauma is another important cause. He said this can happen, for example, when someone suffers a severe car accident and, not wearing a seatbelt, strikes their chest hard against the steering wheel, an impact that can injure the heart and trigger tamponade. Gismondi stressed that this was not what happened in the case of the teacher being discussed.
Despite how serious it can be, cardiac tamponade is considered a rare complication that does not occur often.
Symptoms to watch for
According to Vinícius, the most common symptoms are shortness of breath, intense fatigue, chest pain, palpitations and a feeling of fainting.
He said an important point is that the severity depends not only on how much fluid accumulates but, above all, on how quickly it builds up in that space.
Telling it apart from anxiety
Gismondi explained how doctors can distinguish tamponade symptoms from an anxiety attack. Diagnosis of the rare condition is made through an echocardiogram, a type of ultrasound of the heart, which shows the fluid buildup and the compression of the organ.
In anxiety, the body's stress response is activated, which tends to raise blood pressure while the patient's veins stay normal. In cardiac tamponade, the opposite happens: blood pressure drops and the veins become visibly swollen because blood cannot return properly to the heart.
How it is treated
One of the procedures used in emergency situations is pericardiocentesis, in which a needle is inserted into the pericardial space to drain the accumulated fluid.
Gismondi said that once a cardiac surgeon takes over a case, they carry out a more detailed evaluation, usually ordering a CT scan in addition to the echocardiogram.
Can it be prevented
Specialists said that because tamponade is not a specific disease but rather a complication linked to other health conditions, the best approach is to pay attention to warning signs from the body and undergo routine checkups.
Vinícius said it is important to properly monitor illnesses that can cause pericardial effusion and to keep conditions such as inflammatory diseases, infections and kidney problems under control. He added that patients who have undergone heart surgeries or procedures also need ongoing follow-up.
Gismondi said that because it is such an uncommon condition, it is understandable that an initial diagnosis can be challenging and mistaken for something else, which makes it all the more important to seek specialized medical help quickly.
