Hemopericardium - causes, symptoms, diagnosis and treatment

Hemopericardium - threatening condition caused by the presence of blood in the pericardium, leading to compression (tamponade) of the heart, a sharp disturbance of hemodynamics and cardiac activity. Acute massive hemopericardium can lead to congestive heart failure and patient death. Hemopericardium considered in cardiology as a special case of pericarditis, namely - hydropericardium.

Pericardial cavity is a slot-like space between the parietal and visceral leaf of the outer lining of the heart tissue. The cavity includes a number of isolated sinuses (sinusitis): anteroinferior (between the sterno-costal and diaphragmatic part of the pericardium), transverse (connecting the back of the pericardium from the front) and oblique (bottom rear of the pericardium between the inferior vena cava and pulmonary veins). When hemopericardium blood accumulates in anteroinferior sinus.

chest injuries (impact, fall), pericardial injury (isolated and combined with a heart injury), closed heart damage and large vessels.

Penetration of the blood in the pericardial cavity hemopericardium development may occur after surgery on the heart and blood vessels (particularly at seams failure imposed on the heart muscle). When used during heart surgery transsternalnogo access without opening the pleura there is a risk of increasing hemopericardium due to lack of blood flow into the pleural cavity. Perforation of the heart and hemopericardium development could complicate the conduct of diagnostic and therapeutic procedures: sensing cavities of the heart, angiography, myocardial biopsy, and pericardial, pacemaker implantation, catheter ablation of accessory pathways, intracardiac injection, central venous catheterization, sternal puncture.

By the occurrence of non-traumatic hemopericardium lead breaks or pericardial coronary vessels, gaps acute or chronic postinfarction heart aneurysm, aortic aneurysm breakthrough in the pericardial cavity. Hemopericardium with heart failure due to myocardial echinococcosis, gummy myocarditis, myocardial abscess leads to fatal cardiac tamponade.

Also hemopericardium can be observed in primary tumors of the pericardium and the myocardium (hemangioma, angiosarcoma), hemophilia, hemorrhagic diathesis.

Hypotension and impaired blood flow leading to hypoxia, anemia and internal organs, especially the brain.

When hemopericardium emerging cardiac tamponade in a patient report pain in the heart, weakness, increasing feelings of anxiety and fear, sweating, cyanosis of the skin and mucous membranes, fainting. There tachycardia with weak pulse (pulse pressure less than 10 mmHg), heart tones - deaf, not listening, cardiac impulse is not detected, the patient's general condition is described as serious. It is seen swelling of the veins of the neck, upper extremities and face.

The accumulation in the pericardial cavity of 400-500 ml of blood is considered to be extremely dangerous for the life of the patient, as it leads to cardiac arrest. In the case of the rapid accumulation of blood in the pericardial cavity of death from tamponade occurs within a few seconds or minutes after hemopericardium development.

heart surgeon based on the characteristic clinical manifestations, explore possible causes of the disease, these chest radiography, electrocardiography (ECG), echocardiography (echocardiography), pericardiocentesis.

Take into account the suddenness of onset of symptoms, the probability of getting a chest injury, the fact of surgical or diagnostic procedures on the heart and blood vessels, the presence of suspected mediastinal tumor, aneurysm of the heart or aorta, infectious myocarditis, etc. Examination of the patient with hemopericardium allows auscultation to identify voiceless heart tones, or lack thereof, expansion of percussion boundaries relative and absolute cardiac dullness, palpation to determine the disappearance of the apical impulse.

For electrocardiogram hemopericardium characterized by reduced voltage ventricular complexes, for changes that reflect the basic pathology of the heart (myocardial infarction). Echocardiography gap echoes between the walls of the heart and pericardium can detect the presence of even a small size hemopericardium.

Hemopericardium confirmed diagnosis of X-ray of the chest is an increase in the shadow of the heart in all directions, smoothness heart arcs amplitude reduction or absence of contours ripple. When a patient with a satisfactory condition hemopericardium perform dynamic X-ray, which allows to set the speed of blood accumulation in the pericardium from the increase in the shadow of the heart.

To clarify the etiology hemopericardium may conduct additional tests: perikardioskopii, pericardial biopsy, if necessary - a diagnostic puncture pericardium (pericardiocentesis), cytological, bacteriological analysis of pericardial fluid. The progression of cardiac tamponade during hemopericardium complicates further examination of the patient and accurate diagnosis.

It should be a differential diagnosis with non-inflammatory hemopericardium hydropericarditis, hiloperikardom, pnevmoperikardom, acute exudative pericarditis (fibrous-serous, hemorrhagic) and myocarditis.

bleeding into the pericardial slit; with an increase hemopericardium and obvious signs of cardiac tamponade - surgical drainage of the pericardial cavity, or the pericardium puncture (pericardiocentesis) with aspiration of the accumulated blood. Pericardiocentesis at hemopericardium operate under mandatory ECG monitoring, echocardiography and hemodynamic monitoring parameters.

At the same time carried out resuscitation on the full compensation of blood loss and restoration of homeostasis. Depending on the etiology hemopericardium further underlying disease being treated.