Pericardial tamponade
definition
The pericardium tamponade is an acute and life-threatening clinical picture in which there is an accumulation of fluid inside the pericardium, which can be accompanied by severe functional impairments of the heart muscle. The heart muscles are surrounded by several layers of connective tissue. The so-called Pericardium, also known as the pericardium, shields the heart from the rest of the organs in the chest and stretches and moves in synchronism with the heartbeat. Between the pericardium and the heart there is about 20-50ml of a lubricating fluid to enable the heart to move smoothly in the pericardium. Various causes can cause an increase and accumulation of fluids in the pericardium. They can be symptom-free as a side effect of many diseases. However, if there is a functional impairment and thus life-threatening symptoms, one speaks of a tamponade.
treatment
The treatment of the pericardial tamponade must be carried out early and professionally in intensive medicine. The aim of therapy is to alleviate the acute symptoms and prevent them from recurring. In acute situations, the body often has to be given fluids via an infusion in order to maintain the heartbeat and the supply of blood to the body. In order to relieve the heart and restore the possibly restricted heart function, the pericardium can be punctured to drain the effusion. Puncturing the pericardium is only useful if the underlying disease does not lead to immediate further cardiac tamponade. Depending on the causal disease, a puncture can be sufficient as the sole therapy or only last for a few minutes. In any case, adequate therapy for the underlying disease, for example heart attack, aortic dissection or pericardial inflammation, must follow in order to avoid further complications.
Puncture
Puncturing the pericardium is a risky procedure that should only be carried out under intensive inpatient monitoring with a view to the function of the heart, circulation and breathing. Under ultrasound control, the fluid-filled space between the pericardium and the heart muscle is punctured with a needle in order to drain the fluid. With pericardial tamponade, the puncture is often done to relieve the acutely distressed heart and to restore the circulatory function. At the same time, however, the effusion can be used to determine whether there is a bloody effusion or a purulent effusion as a result of an infection. Individual pathogens can even be recognized on the basis of the liquid obtained. The pericardium is usually punctured with adequate anesthesia and sedation.
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complication
The pericardial tamponade itself represents a life-threatening complication of serious diseases of the heart or the lungs. The threatening complication of the pericardial tamponade is a further limitation of the heart function, which can lead to cardiovascular arrest in various ways. Potential blood loss through bleeding into the pericardium and thorax can also lead to severe shock with a lack of blood volume and cardiac arrest.
forecast
The prognosis depends very much on the extent and cause of the pericardial tamponade. In principle, it is a life-threatening, highly acute clinical picture. Cracks in the heart muscle or pericardial tamponades that are triggered by infarcts or aortic dissections are often fatal within seconds, so that there is no diagnosis or treatment. Less acute courses of a heart attack or other damage to the cardiovascular system can in most cases be treated well in intensive care. In less acute cases, the prognosis of pericardial tamponade usually agrees with the prognosis of the underlying disease. Even with adequate treatment, damage to the heart muscle can persist over the long term.
Course of disease
The course of the disease can be very different. In the majority of cases, pericardial tamponade is a very rapid and acute clinical picture that requires urgent, immediate intensive care treatment. If the triggering event, such as a heart attack, occurs suddenly, bleeding into the pericardium can occur, which slowly expands. First, the pericardium expands with the effusion. Later, however, the fluid presses on the heart muscle, which means that it cannot fill up enough and the circulatory function is restricted. Within a very short time it can lead to severe hypoperfusion of all organs and a loss of consciousness.
How often is that fatal?
Most pericardial tamponades are diagnosed when death has already occurred. Often the pericardial tamponades arise as a result of heart ruptures that are fatal within seconds to minutes, so that there is no possibility of treatment. If, on the other hand, a pericardial tamponade is clinically diagnosed, it can often be treated with a puncture. The prognosis of slow-moving pericardial tamponades therefore depends on the underlying disease.
causes
There are many causes that can cause unusual build-up of fluid in the pericardium. The nature of the fluid in question can provide important information about the underlying disease. There may be clear or cloudy fluids, pus or blood. Important causes of acute pericardial tamponades are injuries to the heart. These can be externally inflicted injuries such as gunshots, stitches or surgical and medical interventions. Injuries without external influences such as rupture of blood vessels or tears from high blood pressure, ventilation, as well as acute illnesses such as heart attacks or collapsed lungs can cause bleeding into the pericardium. Cloudy or purulent effusions, on the other hand, can be attributed to infections or malignant diseases in the chest. These are usually less acute and slower progressing diseases. The increasing effusion in the pericardium leads through various mechanisms to pressure on the heart muscle and a functional restriction, whereby the supply of the organs with blood is disturbed and numerous, fatal complications can occur.
Heart attack
A heart attack is a common cause of pericardial tamponade. The pericardium, on the other hand, represents one of the most dangerous complications of a heart attack. The mechanism that causes a heart attack is an occlusion of a coronary artery, whereby a certain area of the heart muscle that was supplied by the blocked artery is cut off from the blood supply. Due to the sudden lack of oxygen, the heart muscle cells die, making the tissue fragile, brittle and can die. The heart muscle can tear immediately or later as a result of high pressure or medical intervention, causing the pericardium to suddenly fill with blood and compress the heart from the outside.
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Aortic dissection
Aortic dissection is itself a highly acute and life-threatening clinical picture in which there is a tear in the inner vessel wall of the aorta, the main artery. The aorta leaves the heart at the top, turns down in the aortic arch and runs through the chest and abdomen towards the pelvis. In its course, the inner vascular wall can tear acutely, causing the blood to flow into the muscles of the aorta and causing severe circulatory disorders. The danger of a rupture of the aorta is particularly threatening, which means that the blood can flow into the chest, abdomen or pericardium in a very short time and, in addition to severe blood deficiency, causes numerous other symptoms. The pericardium tamponade is a dangerous complication of aortic dissection, which also has a negative effect on the heart function and the blood circulation in the body, often with fatal outcome.
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I recognize a pericardial tamponade by these symptoms
The symptoms of pericardial tamponade can appear very suddenly. When it comes to symptoms, however, the symptoms of the underlying disease are often in the foreground. General unspecific symptoms of pericardial tamponade result from the functional impairment of the heart. These can be tiredness, reduced performance, dizziness, drowsiness, impaired consciousness or even loss of consciousness. The physical examination may also reveal that the jugular veins are congested and dilated, as well as accelerated heart and breathing rates, low blood pressure, shortness of breath, cold hands and feet, a feeling of pressure in the chest and decreased urine output. The symptoms of the underlying diseases can vary greatly with the type and extent of the underlying disease. Often it is chest pain, shortness of breath, radiation of pain to the arm, jaw or shoulder blade, cold sweat, more rarely fever and symptoms of infection.
diagnosis
The diagnosis of pericardial tamponade must be made as quickly as possible, as the clinical picture can be fatal within a short time and timely treatment can significantly change the prognosis. The first indications for making a diagnosis come from the typical symptoms and physical symptoms. Those affected often have severe chest pain, weakness, shortness of breath or even loss of consciousness. The palpable pulse on the wrist can be weak, barely present, or irregular. The diagnostic emergency measures for life-threatening diseases of the heart are furthermore an EKG, a sonography of the heart, as well as an early radiological representation, for example by means of a CT examination or cardiac catheter examination. In the EKG, typical changes in cardiac muscle damage and heart attack can be recognized. For the diagnosis of pericardial tamponade, sonography of the heart, the so-called "heart echo", is also important. Even small effusions in the pericardium can be diagnosed here. The functional restrictions, the degree of filling of the heart chambers, the movement of the heart muscle and the amount of blood ejected can also be measured in the heart echo. The heart echo can also be used therapeutically to monitor and plan the puncture of the pericardium. The representation of the blood flow and the blood vessels in the CT or the catheter examination also allows a precise diagnosis of the cardiac blood flow and also reveals a pericardial tamponade.
