Heart disease is one of the three most common pathologies. They equally often affect young and old people. Cardiac tamponade is a dangerous disease that often leads to death. The person requires immediate medical attention.
The presented pathology requires not only conservative therapy, but also a surgical operation. Moreover, the second way is used in almost every case. With cardiac tamponade, the causes and symptoms are clarified at the examination by a cardiologist.
What is a disease?
Any person has a small amount of fluid in the pericardium - up to 40 ml. This figure is considered normal. But with cardiac tamponade, there is too much fluid. It fills the space between the membranes covering the muscle tissue.
It can be either exudate or blood. Sometimes between the shells contains lymph and pus. As a result of the accumulation of fluid, the organ shrinks and cannot perform its functions normally. Filling the cavities of the heartnot enough. It can't shrink like it used to. There is a decrease in venous inflow and cardiac output.
Cardiac tamponade with blood is even more dangerous. Up to 1 liter of fluid can accumulate in the pericardium, which is already a danger to life, because the organ cannot function normally.
Classification
Cardiac tamponade can be different. The prognosis depends on the exact definition of the type of disease. There are such types of it:
- Spicy. It develops rapidly, and its symptoms are pronounced. Up to 250 ml of fluid is poured into the pericardial cavity. The course of the disease is very difficult to predict. A person needs urgent medical help.
- Chronic. The pericardial space is filled gradually. In the end, there is 1-2 liters of liquid there. Here the prognosis is more favorable, since the life-threatening condition does not arise too quickly. Doctors have time to solve the problem.
- Spontaneous. Tamponade develops due to defects in the cardiac membranes or vessel walls.
The prescribed therapy, as well as its effectiveness, depends on the type of disease. Tamponade is uremic, bacterial, viral, or neoplastic.
Reason for development
Causes of cardiac tamponade are:
- Open or closed chest injury, accompanied by damage to the organ.
- Radiation exposure.
- Malignant or benign neoplasm.
- Excessive dehydration.
- Blood pressure problems.
- Hypothyroidism or other dysfunction of the endocrine system.
- Myocardial infarction or heart failure.
- Long-term use of blood thinners.
- Hemodialysis causing kidney failure.
- Prolonged course of chronic pathologies.
- Mixedema.
- Rheumatism.
- Tuberculosis.
- Severe fungal infection.
- Rupture of a dissecting aortic aneurysm.
- Surgical removal of myocardial tissue or probing of cardiac chambers.
- Leukemia.
Chronic type of tamponade is often caused by systemic pathologies that lead to connective tissue damage. Particular attention should be paid to the development of the disease in babies under one year old.
Signs and symptoms
The symptoms of cardiac tamponade vary. It all depends on the form of pathology. You can distinguish the following signs of the disease:
- Significant deterioration in well-being.
- Pain and discomfort in the chest area.
- Excessive psychological stress.
- Lack of breath, shortness of breath.
- Cold sweat.
- Sickness and weakness.
- Impaired pulse.
- Cyanosis of the skin (acquisition of a blue tint by it).
- Increased anxiety and fear of death.
- Disturbed appetite.
- A muffled heart sound is heard, along with a pericardial rub.
In difficult cases, the patient is dizzy,loss of consciousness, as well as hemorrhagic collapse. The chronic form is characterized by an increase in the volume of veins, a change in the size of the liver, difficulty breathing during exercise.
Diagnostic features
Diagnosis of cardiac tamponade should be complex and differential. It provides for the following studies:
- Physical examination by a cardiologist and recording of patient complaints.
- ECG for cardiac tamponade. It is not used very often, but it will allow you to calculate the heart rate.
- X-ray. The picture shows the outlines of the organ, which expand in all directions. There is also a smoothness of the shadow of the heart on the left. The picture shows no signs of stagnation in the respiratory organs, there is a decrease in the left ventricle during the relaxation period.
- Echocardiography. Thanks to it, the presence and amount of liquid is determined. Also, the study is regularly carried out in order to track the dynamics of the patient's recovery after a surgical operation. The result of the diagnosis: the degree of collapse of the inferior vena cava on inspiration decreases, the cavity of the lower cardiac chambers decreases, the sheets of the pericardium diverge.
- MRI. The study allows you to identify the disease at an early stage. It provides layer-by-layer analysis of soft tissues with the ability to detect the smallest lesions.
- Ultrasound. Analysis detects fluid in the pericardial region.
- Bacterial seeding and biopsy of the resulting fluid. It is necessary to clarify the diagnosis.
- Pulsed Doppler of vessels.
- Catheterizationcavities of the heart. This is an invasive technique that is used during surgery. The received data is as reliable as possible.
An examination of the internal organs is also carried out. You can't go wrong with diagnostics. It is necessary to distinguish tamponade from constrictive pericarditis, myocardial insufficiency.
In children, ultrasound and puncture are the most informative studies. Other diagnostic methods are not applicable.
Emergency
With serious pathologies of the heart, the patient sometimes needs urgent medical attention. Cardiac tamponade is often fatal if the patient does not receive timely assistance. An attack can happen at any moment. If a person becomes ill at home, he needs to provide emergency care and call doctors.
At the time of the attack, you should not give the victim any drugs, as the blood pressure will drop even more. It is important to provide a person with maximum comfort. After the arrival of doctors, you need to describe in detail and accurately the condition of the person.
First of all, in a hospital, a pericardial puncture is done. A needle with an expanded end is inserted into this area and excess fluid is pumped out. The injection site is the region of the left 7th rib. The needle is inserted 1.5 cm deep, directed upwards and pushed even deeper (3-5 cm). When the procedure is carried out correctly, liquid begins to flow.
The procedure is carried out under the supervision of an ultrasound or X-ray. The operation allows only to alleviate the patient's condition for a while. If the cause is not corrected, the problem will return. Afterpuncture, the pericardial cavity is washed with sclerosing, antiseptic agents or antibiotics. Commonly used drugs are Hydrocortisone, Prednisolone.
With cardiac tamponade, emergency care reduces the risk of death.
Traditional Therapy
Therapy is considered successful if the cause of the development of the pathology is eliminated, and the condition is stabilized. The patient's condition should improve markedly.
After the acute cardiac tamponade is stopped, maintenance therapy with medications is carried out. The patient is infused with an infusion solution: metabolic drugs or blood plasma.
To restore normal processes of nutrition and metabolism in the myocardium, to improve tissue regeneration, doctors prescribe "Mildronate", "Carnitine" to a person. If, due to the filling of the pericardium with fluid, the patient has complications, then the treatment is directed to the relief of pathological conditions.
If the cause of tamponade is successfully eliminated, then after a few days the patient is discharged from the hospital and continues therapy on an outpatient basis at home.
Do I need surgery?
Treatment of cardiac tamponade is not only conservative. If the risk of recurrence is high, then surgery is performed. The indication for the procedure is: rupture of the heart, calcification or cicatricial changes in the pericardium, chronic formation of exudatein the pericardial sac.
The patient is usually scheduled for this intervention:
- Pericardiotomy. The wall of the pericardium is dissected in order to drain its cavity, remove excess fluid, and identify pathological foci.
- Subtotal pericardectomy. Complete removal of the fragment, except for the part adjacent to the back of the cameras.
After surgery, the patient needs recovery. It is important to avoid heavy physical exertion, stressful situations, eat right.
Features of drainage
The pericardium is a heart bag that tends to stretch, so the clinical picture changes. With its rapid filling with liquid, the patient develops a state of shock. Immediate drainage required.
Liquid removal cannot be done quickly. If 1 liter is present in the pericardium, then the elimination procedure lasts about 40 minutes. Otherwise, the patient's blood pressure is greatly reduced. Hypotension can last a week. However, the patient's response to therapy is negligible.
This reaction is associated with an overload of the right heart chambers, a violation of the restoration of the functionality of the myocardial muscles.
Early complications
If the treatment of cardiac tamponade was not carried out on time or was ineffective, then the patient develops complications. They appear both at the moment of direct filling of the organ with blood, and some time after that. Disadvantages include:
- Arrhythmia.
- Myocardial infarction.
- Cardiogenic shock.
- Sudden death.
The chronic course of the disease causes late complications:
- Fibrous pericarditis (inflammation of the connective tissue of the organ sac).
- Violation of impulse conduction between the ventricles and atria.
Consequences gives and puncture of the pericardium. The patient may develop cardiac sclerosis. With timely detection and proper treatment of pathology, the prognosis is favorable.
Prevention of pathology
The causes and symptoms of cardiac tamponade should be known to those people who have an increased risk of developing cardiac pathologies.
The presented disease can be prevented, but for this you need to follow the following preventive measures:
- Anticoagulants and other cardiac medications should only be taken as directed and in consultation with your doctor.
- Treat any infectious and inflammatory diseases in time.
- Avoid chest injury.
- Entrust invasive cardiac procedures only to professionals.
- Eat properly and rationally.
It is difficult to talk about individual consequences, since the causes of occurrence are different, and not all of them can be completely eliminated.
To avoid death or serious consequences, it is necessary to undergo diagnostics and therapy of cardiac diseases in time. You will also have to constantly be under the control of a doctor.
