Cardiac tamponade: causes and prognosis
Tamponade of the heart is a disease in whicha large amount of fluid is collected in the cardiac bag, which causes difficulty in contracting the atria and ventricles. As a consequence, there is a significant decrease in minute and systolic volumes. A distinctive feature of this syndrome is an increase in central venous pressure and the creation of conditions for the development of heart failure.
Such an increase can be considered protectivecompensating reaction of the body, as this keeps the influx to the heart of the blood until the pressure in the large veins is exceeded in comparison with the pressure in the pericardial sac. One of the causes of cardiac tamponade is bleeding into the pericardial sac due to a wound in the heart, a heart attack or a rupture of the aorta inside the pericardium. The inflammatory process of the pericardium develops edema, which leads to the accumulation of fluid in the heart. Cardiac tamponade can be provoked by the development of a tumor in the pericardium, but this is relatively rare.
The main causes of nontraumatic tamponade are uremic, tumor and idiopathic pericarditis.
Diagnosis
Tamponade of the heart is manifested by such clinical symptoms as impairment of peripheral circulation under various shock conditions. These include:
low blood pressure;
- almost complete disappearance of the pulse in the arteries on the periphery of the body;
- cyanosis of the skin and a decrease in its temperature;
- oliguria;
- sometimes loss of consciousness due to lack of blood circulation in the brain.
With high central venous pressure in a numbercases of jugular veins are excessively filled. In doubtful cases, this pressure is measured using a catheter. To do this, it is connected to the internal jugular vein or to the subclavian vein, and then connected to a water manometer. Usually, with cardiac tamponade, the central venous pressure is above 1.96 kPa.
Identify a person with a cardiac tamponade using a diagnostic method such as echocardiography.
If it is impossible to determine the root cause when studying anamnesis and physical examination. To clarify the diagnosis will help such studies:
• Study for tuberculosis (skin tests and others).
• Conduct urine tests to exclude or confirm a nephrotic syndrome and renal failure.
• Examination of the thyroid gland.
• Search for a tumor (especially the breast or lung).
Cardiac tamponade, treatment
If there are signs of cardiac tamponadeit is required to immediately remove liquid from the pericardium by puncture or surgically. Immediate surgical intervention should be carried out with wounds of the heart and with a rapid buildup of purulent exudate. If pericardial puncture is difficult or if it does not give the expected improvement, you can alleviate the patient's condition for a short time to prepare for the operation. To do this, a rapid intravenous injection of dextran or other liquids filling the vascular bed and increasing central venous pressure is performed.
Suspend accumulation in the pericardium of serousExudate can be applied by using steroid hormones. Cardiac tamponade in patients with pericarditis, which has developed as a result of rheumatism or a heart attack, is successfully treated with hormonal medications, which allows to refuse pericardial puncture.
Thus, without timely treatmenttamponades of the heart in most cases can be fatal. The doctor first determines what was the cause of this disease, and also assesses the degree of severity of the patient's condition. If the cardiac tamponade is associated with inflammatory processes, then there is the possibility to limit ourselves to only conservative methods of its treatment. All other cases require urgent surgical intervention. The fluid in the pericardium is removed by carrying out a pericardiocentesis (puncturing the pericardial cavity with the needle and aspirating the contents) or by removing the damaged portion of the pericardial sac.
