Heart diseases are one of the three most common pathologies. They equally often affect young and old people. Heart tamponade is a dangerous disease that often leads to death. A person needs immediate medical attention.
The presented pathology requires not only conservative therapy, but also surgery. Moreover, the second way is used in almost every case. With cardiac tamponade, the causes and symptoms are clarified by a cardiologist.
What is a disease?
Any person has a small amount of fluid in the pericardium - up to 40 ml. Such an indicator is considered normal. But with tamponade of the heart, the fluid becomes too much. It fills the space between the membranes covering the muscle tissue.
It can be both exudate and blood. Sometimes between the membranes contains lymph and pus. As a result of the accumulation of fluid, the organ contracts and cannot normally perform its functions. Filling the cavities of the heart is not enough. It cannot be reduced as before. There is a decrease in venous flow and cardiac output.
Blood cardiac tamponade is even more dangerous. Up to 1 liter of fluid can collect in the pericardium, which already represents a danger to life, because the organ cannot function normally.
Classification
Cardiac tamponade may be different. The prognosis depends on the exact determination of the type of disease. There are such types of it:
- Sharp. It develops rapidly, and its symptoms are pronounced. Up to 250 ml of fluid is poured into the pericardial cavity. It is very difficult to predict the course of the disease. A person needs urgent help from doctors.
- Chronic The pericardial space is filled gradually. In the end, the liquid there is 1-2 liters. Here the forecast is more favorable, since a life-threatening condition does not occur too quickly. Doctors have time to solve the problem.
- Spontaneous. Tamponade develops due to defects in the heart membranes or vessel walls.
The type of disease depends on the prescribed therapy, as well as its effectiveness. Tamponade has a uremic, bacterial, viral or tumor character.
Development reasons
The causes of cardiac tamponade are:
- Open or closed chest trauma, accompanied by organ damage.
- Radiation exposure.
- A neoplasm of a malignant or benign nature.
- Excessive dehydration.
- Blood pressure problems.
- Hypothyroidism or other impaired functionality of the endocrine system.
- Myocardial infarction or rupture of the heart.
- Long-term use of blood thinners.
- Hemodialysis, provoking renal failure.
- The prolonged course of chronic pathologies.
- Myxedema.
- Rheumatism.
- Tuberculosis.
- Severe fungal infection.
- Rupture of stratified aortic aneurysm.
- Surgical removal of myocardial tissue or sounding of the heart chambers.
- Leukemia
The chronic type of tamponade often causes systemic pathologies that lead to damage to the connective tissue. Particular attention should be paid to the development of the disease in babies up to a year.
Signs and Symptoms
With cardiac tamponade, the symptoms appear in different ways. It all depends on the form of pathology. The following signs of the disease can be distinguished:
- Significant deterioration in well-being.
- Pain and discomfort in the chest area.
- Excessive psychological stress.
- Lack of air, shortness of breath.
- Cold sweat.
- Malaise and weakness.
- Impaired heart rate.
- Cyanosis of the skin (its acquisition of a blue hue).
- Increased anxiety and fear of death.
- Impaired appetite.
- A muffled heart tone is heard, and there is also the noise of pericardial friction.
In difficult cases, the patient has dizziness, 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 such 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.
- Roentgenography. The image shows the outline of an organ that expands in all directions. Smoothness of the shadow of the heart on the left is also noted. The picture shows no signs of stagnation in the respiratory organs, the left ventricle subsides during relaxation.
- Echocardiography. Thanks to it, the presence and amount of liquid is determined. A study is also regularly conducted to track the dynamics of patient recovery after surgery. Diagnostic result: the degree of subsidence of the inferior vena cava on inspiration decreases, the cavity of the lower heart chambers decreases, the pericardial sheets diverge.
- MRI The study allows you to identify the disease at an early stage. It provides a layered analysis of soft tissues with the possibility of detecting the smallest lesions.
- Ultrasound The analysis detects fluid in the pericardial region.
- Bacterial culture and biopsy of the resulting fluid. It is necessary to clarify the diagnosis.
- Pulse Dopplerography of blood vessels.
- Cardiac catheterization. This is an invasive technique that is used during surgery. The received data is the most reliable.
An examination of the internal organs is also carried out. You can’t pull 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 used.
Urgent Care
With serious heart pathologies, the patient sometimes requires urgent medical attention. Cardiac tamponade often leads to death if the patient does not receive timely care. An attack can happen at any time. If a person becomes ill at home, he needs to provide emergency care and call a doctor.
At the time of the attack, one should not give the victim any drugs, since the blood pressure will decrease even more. It is important to provide the person with maximum comfort. After the arrival of doctors, it is necessary to describe in detail and accurately the state of the person.
First of all, in a hospital, 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 area of the left 7th rib. The needle is inserted 1.5 cm deep, goes up and pushed even deeper (3-5 cm). With the right procedure, fluid begins to flow.
The procedure is carried out under the supervision of an ultrasound or X-ray. The operation can only alleviate the patient’s condition for a while. If the cause is not resolved, then the problem will return. After the puncture, the pericardial cavity is washed with sclerotizing, antiseptic or antibiotics. Commonly used drugs are Hydrocortisone, Prednisone.
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 noticeably improve.
After acute cardiac tamponade is stopped, supportive therapy with medication is performed. The patient receives 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 complications arise in the patient due to the filling of the pericardium with liquid, then the treatment is directed to stopping the pathological conditions.
If the cause of the tamponade has been eliminated successfully, then after a few days the patient is discharged from the hospital and continues therapy on an outpatient basis at home.
Is surgery necessary?
Treatment of cardiac tamponade is not only conservative. If the risk of relapse is high, then an operation is performed. An indication for the procedure is: heart rupture, calcification or cicatricial changes in the pericardium, chronic formation of exudate in the pericardial sac.
The patient is usually prescribed such an intervention:
- Pericardiotomy The wall of the pericardium is dissected in order to drain its cavity, drain excess fluid, as well as identify pathological foci.
- Subtotal pericardectomy. Complete removal of the fragment, with the exception of the part adjacent to the rear of the chambers.
After surgery, the patient needs recovery. It is important to avoid heavy physical exertion, stressful situations, eat right.
Drainage features
The pericardium is a heart bag that has the ability to stretch, so the clinical picture is changing. With its rapid filling with liquid, the patient develops a shock condition. Immediate drainage is required.
Liquid removal cannot be carried out quickly. If 1 liter is present in the pericardium, then the elimination procedure lasts about 40 minutes. Otherwise, the patient's blood pressure drops significantly. Hypotension is able to last a week. In this case, the patient's response to therapy is negligible.
This reaction is associated with overloading of the right heart chambers, impaired restoration of myocardial muscle functionality.
Early complications
If treatment of cardiac tamponade was not performed on time or was ineffective, then the patient develops complications. They appear both at the time of direct filling of the organ with blood, and some time after that. Unpleasant consequences 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 an organ bag).
- Violation of impulse conduction between the ventricles and atria.
The consequences are also given by pericardial puncture. The patient may develop cardiac sclerosis. With the timely detection and proper treatment of pathology, the prognosis is favorable.
Pathology Prevention
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 these preventive measures:
- Anticoagulants and other cardiological drugs should be taken only according to the instructions and after consultation with the doctor.
- In time to treat any infectious and inflammatory diseases.
- Avoid injury to the chest.
- Entrust invasive cardiological procedures to professionals only.
- Eat properly and rationally.
It is difficult to talk about individual consequences, since the causes of the occurrence are different, and not all of them can be completely eliminated.
To avoid death or serious consequences, it is necessary to undergo timely diagnosis and therapy of cardiac diseases. You will also have to be constantly monitored by a doctor.