Tamponada of heart – the clinical syndrome connected with sharp dysfunction of heart and system haemo dynamics owing to bystry accumulation of liquid in a cavity of a pericardium and rise in intra pericardiac pressure. Tamponada of heart can be shown by discomfort in a breast, painful short wind, tachycardia, , paradoxical pulse, arterial hypotonia, swelling of jugular veins, an unconscious state, shock. The diagnosis of a tamponada of heart is based on data of fizikalny survey, EhoKG, the ECG, a X-ray analysis of a thorax, a kateterization of the right departments of heart. At a tamponada of heart the urgent puncture of a pericardium, sometimes - a perikardiotomiya, a subtotal perikardektomiya is shown.
Tamponada of heart
Tamponada of heart – the critical condition caused by the accruing accumulation of liquid in a pericardium cavity, the substantial increase of intra pericardiac pressure, violation of diastolic filling of ventricles leading to sharp reduction of warm emission. On clinical manifestations of a tamponad of heart can be sharp and chronic. Rapid and rapid development of symptoms and unpredictability of a current is characteristic of a sharp tamponada of heart. In cardiology of a tamponad of heart is the dangerous complication leading to the heavy violations of the central haemo dynamics, metabolic and microcirculator frustration promoting development of an acute heart failure, shock and cardiac arrest.
Heart tamponada reasons
Tamponada of heart can develop at a congestion in a pericardiac cavity of an exudate, various on character (to blood, pus, exudate, a transsudat, a lymph), and also gas. The often sharpest tamponada of heart arises at a haemo pericardium - the bleeding in a pericardium cavity developing at the opened and closed injuries of a thorax and heart; owing to holding medical procedures (a biopsy of a myocardium, sounding of heart, installation of the central venous catheter) and surgeries; at stratification of aneurism of an aorta, a spontaneous cardiac rupture at patients with a myocardial infarction, at treatment by anticoagulants.
Tamponada of heart can complicate a current of perikardit (tubercular, purulent, sharp idiopathic), malignant tumors of heart and lungs, a chronic renal failure, a system red volchanka, a miksedema, etc.
Haemo dynamics at a heart tamponada
Violations of haemo dynamics at a tamponada of heart depend not so much on the volume how many from the speed of intake of liquid and degree of tensile properties of a pericardium. Normal the cavity of a pericardium contains about 20-40 ml of liquid, intra pericardiac pressure makes about 0th mm Hg. Thanks to adaptation ability of a pericardium slow accumulation to 1000-2000 ml of an exudate leads usually to minor change of intra pericardiac pressure.
At sudden receipt in a pericardium cavity even of a small amount (more than 100-200 ml) of exudate there can be a sharp rise in intra pericardiac pressure leading to a sdavleniye of heart and intraperikardialno the located sites of the top and lower hollow veins. The obstacle to inflow of blood to ventricles is created that leads to decrease in their filling during a diastola, to reduction of shock volume and warm emission.
Normal at the end of a diastola pressure in the right auricle and a ventricle equals about 7 and 5 mm of mercury. respectively, in the left auricle and a ventricle - to 14 and 12 mm of mercury. Tamponada of heart develops when intra pericardiac pressure becomes equal to the final diastolic pressure (FDP) in ventricles.
Increase in the central venous pressure (CVP), characteristic of heart tamponada, increase in ChSS and increase in peripheral resistance is the compensatory mechanism directed to preservation of adequate filling of heart and its emission. Tamponada of heart with low intra pericardiac pressure can arise at decrease in the intra vascular volume (gipovolemiya) at the dehydrated patients in critical condition.
Heart tamponada symptoms
Clinical manifestations of a tamponada of heart are caused by sharp decrease in pump function of heart and warm emission. The complaints shown by patients at a heart tamponada usually are not specific: weight in a thorax, increase of short wind, feeling of "fear of death", sharp weakness, plentiful cold sweat. At survey of the patient cyanosis of integuments, psychomotor excitement, tachycardia, the speeded-up superficial breath, the expressed paradoxical pulse, arterial hypotonia, deaf tones of heart is noted. At a sharp tamponada of heart due to powerful activation of simpatoadrenalovy system within several hours HELL can be supported and be observed improvement of venous return.
The clinical picture of the heavy sharp tamponada of heart caused, for example, by a rupture of a myocardium or aorta can be shown by the development of a sudden faint and hemorrhagic collapse demanding urgent surgical intervention without which the patient perishes.
At gradual development (a chronic current) clinical symptoms of a tamponada of heart are similar to displays of heart failure: patients are disturbed short wind at loading and in a prone position (), weakness, appetite loss, swelling of jugular veins, morbidity in the right podreberye, a gepatomegaliya, ascites. The stagnation decompensation in a big circle of blood circulation at a chronic tamponada of heart leads to development of a state of shock.
Diagnostics of a tamponada of heart
It is possible to assume existence of a tamponada of heart at simultaneous development in the patient of short wind, tachycardia or , the raised TsVD, low HELL, paradoxical pulse in the absence of signs of insufficiency of the left ventricle. Paradoxical pulse is not a characteristic symptom of a tamponada of heart and can also accompany HOBL, a bad attack of bronchial asthma, TELA, a myocardial infarction of the right ventricle, konstriktivny perikardit. Paradoxical pulse can be absent at patients with tamponady hearts at sharp or chronic aortal insufficiency, DMPP, heavy hypotension, a local compression of a myocardium (for example, massive clots of blood).
The echocardiography at a tamponada of heart has the highest diagnostic value as allows to find even the small volume of an exudate in a pericardium cavity, and also existence of a diastolic collapse of the right cameras of heart and change of speed of a blood-groove via trikuspidalny and mitralny valves on a breath. Chrespishchevodny EhoKG is carried out at emergence of signs of a tamponada after surgical intervention on heart, at difficulties of identification of a pericardiac exudate.
ECGs manifestations of a tamponada of heart are usually not specific (low amplitude of the QRS complex, the flattened or negative teeth of T, at the large volume of an exudate - full electric alternation of teeth of P and T and the QRS complex). The thorax X-ray analysis at a heart tamponada often reveals the increased heart shadow with the weakened pulsation, lack of venous stagnation in lungs.
Kateterization of the right departments of heart allows to confirm the diagnosis of a tamponada of heart and to estimate expressiveness of haemo dynamic violations. Pulse doppler sonography at a tamponada of heart shows dependence of a blood-groove via heart valves from respiratory excursions (reduction of a transmitralny blood-groove on a breath> 25%, reduction of a transtrikuspidalny blood-groove on an exhalation> 40%). Tamponadu needs to differentiate hearts from a konstriktivny perikaryodit and heavy miokardialny insufficiency.
Treatment of a tamponada of heart
In communication the life-endangering state at all cases of a tamponada of heart showed urgent evacuation of pericardiac liquid by carrying out a puncture of a pericardium (perikardiotsentez) or surgical intervention (at traumatic and postoperative genesis of a tamponada). For ensuring haemo dynamic support for a tamponada of heart carry out infusional therapy (intravenous administration of plasma of blood, nootropic means).
The puncture of a pericardium is carried out under obligatory control of EhoKG or roentgenoscopy, with continuous monitoring of AD, ChSS, TsVD. The expressed clinical effect of a perikardiotsentez at a tamponada of heart is swept up already at aspiration from a cavity of a pericardium of 25-50 ml of liquid. After removal of an exudate antibiotics, hormonal medicines, skleroziruyushchy means can be entered into a pericardiac cavity according to indications. For the prevention of repeated accumulation of an exudate in a cavity of a pericardium the drainage for continuous outflow of liquid is established. Further treatment of the main disease for prevention of development of a recurrence of a tamponada of heart is carried out.
At high risk of a repeated tamponada of heart preference is given to the surgical treatment (to a perikardiotomiya, a subtotal perikardektomiya) providing fuller drainage of a cavity of a pericardium. Urgent surgery according to vital indications is performed at a tamponada owing to a cardiac rupture or an aorta.
At a perikardiotomiya in a wall of a pericardium do an opening for drainage of his cavity and carry out audit of an internal surface for identification of a traumatic haemo pericardium or the tumoral centers. The subtotal perikardektomiya is a radical method of treatment of a tamponada of heart at a chronic ekssudativny perikardit, cicatricial changes and calcification of a pericardium.
Forecast and prevention of a tamponada of heart
In due time not diagnosed tamponada of heart leads to a lethal outcome. The situation at development of a haemo pericardium and tamponada of heart in case of a considerable injury or a cardiac rupture, stratification of aneurism of an aorta is unpredictable. At early diagnostics and rendering the necessary medical help at a heart tamponada the next forecast usually blagoyopriyatny, remote - depends on a disease etiology.
Prevention of a tamponada of heart includes timely treatment of perikardit, observance of the technology of holding invasive procedures, monitoring of a condition of the curtailing system of blood at therapy by anticoagulants, therapy of associated diseases.