Cardiac tamponade - a kind of clinically acute syndrome, which has a direct connection with a flagrant violation of the heart and its hemodynamics due to the rapid accumulation of fluid in the pericardium and increase the pressure inside the pericardium.Cardiac tamponade can be characterized by chest discomfort, severe dyspnea, tachypnea, sinus tachycardia, paradoxical pulse, lowering blood pressure bulging jugular veins, fainting or shock.
The diagnosis of "cardiac tamponade" is based on data from physical examination, electrocardiogram, echocardiography, radiography, catheterization of the right heart.When cardiac tamponade may be indicated emergency pericardiocentesis, and in some cases - pericardiotomy.
Cardiac tamponade causes
When cardiac tamponade hemodynamic instability depends not only on the volume of fluid as it is received from the speed and degree of roominess pericardium.In a normal pericardial it contains about 30-40 ml of fluid, and the pressure insid
known that the level of end-diastolic pressure in the right atrium and ventricle is equal to 8 and 6 mm Hg, while in the left atrium and the ventricle - 16 and 12 mm Hg.Cardiac tamponade is developed in the case where the pressure becomes the same level of end-diastolic pressure in the ventricles.
Cardiac tamponade is a critical condition that is caused by the gradual accumulation of fluid in the pericardium, a substantial increase in pressure inside the pericardium, a violation of the ventricular diastolic filling, which leads to a drastic reduction in cardiac output.According to its clinical signs can be cardiac tamponade, and acute and chronic wear.
Cardiac tamponade develops due to the accumulation in the pericardial cavity of varying the nature of the liquid and gas.The fluid accumulates in the cavity may be provided in the form of blood, lymph, pus, exudate and transudate.
Often, acute cardiac tamponade develops due hemopericardium - bleeding into the pericardial cavity that develops in closed or open injuries of the chest or heart.It can also develop due to the intervention on the organs of the chest (myocardial biopsy, the installation of central venous catheter examination of the heart using a probe, the operation on the respiratory system or heart).There are cases where an acute cardiac tamponade developed due to myocardial infarction, which was followed by a spontaneous rupture of the heart;bundle aortic aneurysm;in the treatment of drugs against increased blood clotting (anticoagulants).
Cardiac tamponade difficult for tuberculosis, idiopathic or purulent pericarditis, substandard tumors of the chest, kidney failure, myxedema, and systemic diseases (lupus erythematosus, etc.).
Cardiac tamponade symptoms
signs of cardiac tamponade are characterized by a sharp limitation of the pumping of the heart and ejection.Patients complain mainly of non-specific nature.Typically, these include: a feeling of tightness of the chest and heaviness, a sense of panic of heart failure, shortness of the growing nature, severe weakness, cold sweat.
at internal examination of the patient often reveal cyanosis of skin and mucous membranes, tachycardia, psychomotor agitation genesis, frequent shallow breathing, paradoxical pulse, hypotension.Auscultation deaf tones are heard in the heart.In acute picture of cardiac tamponade due to the powerful work sympathoadrenal can stand on the same level of blood pressure for some time, and marked improvement of venous return.
Clinic heavy and at the same acute cardiac tamponade, which is caused by rupture of the aorta or myocardium, can manifest itself to the development of syncope and collapse hemorrhagic.These states require urgent surgical operation, without which death occurs.
With slow development, signs of cardiac tamponade are similar to the symptoms of heart failure.Patients concerned about weakness, mild pain in the right half of the chest, loss of appetite, increase in shortness of breath on exertion, ascites and hepatomegaly.
Suspected cardiac tamponade is possible by the joint development of a patient tachypnea, shortness of breath, high blood pressure inside the pericardium, low blood pressure in the absence of symptoms of left ventricular failure.
It is important to ECG or echocardiography, X-ray examination, and in some cases, transesophageal echocardiography.
Cardiac tamponade treatment
Because life-threatening condition when the patient's cardiac tamponade shows emergency evacuation of fluid from the pericardium by a puncture of the pericardium (pericardiocentesis) or surgery.In order to provide hemodynamic support necessary to infusion therapy with intravenous administration of neuroprotective drugs, plasma.
Pericardiocentesis performed under fluoroscopy or echocardiography, with constant observation of blood pressure, heart rate and vnutriperikardialnym pressure.Persistent clinical effect puncture pericardium during cardiac tamponade revealed already at the fence of 30-50 ml of fluid from the cavity.
After the evacuation of the effusion, to the pericardium may be administered antibacterial drugs (antibiotics, or Cephalosporins penitsilinnovogo series), hormonal agents, sclerosing agent.To prevent recurrence of fluid accumulation in the pericardial drainage with a view to establish a permanent evacuation of fluid.
If there is a high risk of recurrent cardiac tamponade, the preference is given to the treatment of this disease surgery (pericardiotomy), which provides the most complete evacuation of fluid from the pericardial cavity.During the pericardiotomy make a hole in the wall to drain the pericardial cavity and produce an audit of its internal surface in order to detect tumor lesions or hemopericardium due to injury.
If time does not diagnose cardiac tamponade, it is in almost all cases in death of the patient.The situation can be unpredictable in the development of cardiac tamponade and hemopericardium due to a heart attack or serious injury, the bundle of an aortic aneurysm.Early diagnosis and medical emergency care in this disease predicts a favorable outcome, and during the rehabilitation process.
Preventive measures when cardiac tamponade is a timely treatment of pericarditis, compliance engineering interventions during invasive procedures, monitoring the state of the blood coagulation system in the treatment of anticoagulant drugs group, treatment of opportunistic diseases.
Cardiac tamponade Emergency
First aid at cardiac tamponade is certain medical activities.Cardiac tamponade develops due to the injury of the chest or heart, pneumothorax, myocardial infarction, etc.When multiple fractures of the ribs make the imposition of a circular immobilizing bandage and conduct percussion of the chest to identify deaf tones characteristic of tamponade.With an open pneumothorax and valves that are opened from the outside, it is made primarily imposition of occlusive dressings on the wound.When
cardiac contusion, primarily relieve pain intravenous Analgin 50% solution in a dosage of 2 ml or 2% solution of Promedol a dosage of 2 ml.When cardiac tamponade produce emergency medical events that are to hold fast pericardial puncture while transporting the patient to the emergency position reclining on a stretcher in the hospital.
in the same position of the patient is carried out in a puncture pericardium in the upper right corner point between the medial segment of the costal arch on the left and the xiphoid process.The fence is made of fluid needle Dufour type, which has a skylight.Puncture produce an oblique upward direction behind the surface of the sternum and costal arches at an angle of 30 ° relative to the surface of the chest.
During puncture of the pericardium from the lumen of the needle to bleed a continuous stream.Pericardial needle is left for the transportation of the patient to determine it in the operating room of thoracotomy and final stop bleeding.