Pericardial tamponade
| Classification according to ICD-10 | |
|---|---|
| I31.9 | Disease of the pericardium, unspecified |
| S26.0 | Traumatic hemopericardium |
| ICD-10 online (WHO version 2019) | |
Under a cardiac tamponade or pericardial tamponade , and cardiac tamponade called, refers to the complication of fluid accumulation (see tamponade ) in the pericardium , a so-called pericardial effusion rarely, or a complication of air accumulation in the pericardium, a so-called Pneumoperikards. Even small amounts of fluid can lead to an obstruction of the ventricle filling, a reduced stroke volume and thus to a life-threatening dysfunction of the heart. In addition, the blood flow in the coronary arteries is reduced and the heart muscle is only insufficiently supplied with oxygen (hypoxia). A heart failure occurs. The fluid can be blood (hemopericardium), serous fluid (hydropericardium), pus (pyopericardium), or chyle (chylopericardium). The heart is compressed from the outside and thus hindered in its function. Above all, the diastolic filling of the heart is impaired.
Pathogenesis
Between the epicardium and the pericardium of the pericardium there is a gap filled with 20–50 ml of lubricant (liquor pericardii), which surrounds the heart and ensures the low-friction mobility of the heart muscle when it contracts or relaxes. Since the pericardium has no possibility of expansion due to its very low elasticity, a rapid increase in fluid in this gap leads to a compression of the heart, as a result of which it can no longer be sufficiently filled with blood and consequently can no longer pump: it pump failure occurs.
In the case of rapid accumulation of fluid in the pericardium, 150–200 ml are sufficient for a tamponade (e.g. in the event of bleeding), while in the case of slow accumulation 1000–2000 ml are necessary for a tamponade, as the pericardium can slowly expand.
causes
- trauma
- Stab or gunshot wound, chest trauma
- Rupture of coronary artery
- extensive myocardial injury , heart rupture
- Lungs and pleural lesions
- (Tension) pneumopericardium v. a. with pneumothorax left or bilateral and PEEP ventilation
- neoplastic diseases
- iatrogenic trauma
- Postoperative bleeding, effusion after surgery
- Myocardial perforation with CVC system in premature and newborn babies
- Incorrect position of the central vein of the left internal jugular vein in the left pericardiophrenic vein
- Perforation with PTCA or by pacemaker probe
- bacterial
- idiopathic, autoreactive
- viral
- uremic
- acute myocardial infarction with rupture of the heart wall
- after irradiation
- Postpericardiotomy Syndrome
- Vasculitis , collagenosis
- Aortic dissection
- Pleural effusion (pronounced)
Symptoms
The main symptoms of a pericardial tamponade (already described by the surgeon Morgagni in 1761 ) consist of an upper congestion with congested neck veins (not in hypovolemia ), the Beck's triad, which includes decreased arterial and increased venous blood pressure ( hypotension ) as well as low heart sounds , shortness of breath ( dyspnea ), a reflex, accelerated heartbeat ( tachycardia ), a pulsus paradoxus up to a cardiogenic shock combined with a cardiovascular arrest. Further symptoms are hunger for air, tachypnea , stagnant urine output, a feeling of oppression, sweating, cold extremities, dizziness, restlessness and acute heart failure with a " low cardiac output ".
Diagnosis
- Inspection : increased jugular vein filling, pallor, cold sweat
- Auscultation : soft heartbeat, tachycardia
- Palpation : Cardiac impulse hardly / not palpable, pulsus paradoxus (drop in syst. BP> 10 mmHg on inspiration)
- ECG : low voltage, electrical alternans, possibly ST segment and T wave changes
- Echocardiography : detection, location, extent of a pericardial effusion
- Chest X-ray: Broadening of the heart silhouette and the upper mediastinum, Bocksbeutel shape of the heart
- CT , MRT : Pericardial effusions or tamponades are easy to visualize and detect, the method too expensive for the critically ill
The method of choice and a safe and quick diagnostic method is echocardiography . As a rule, there is not very much time with a pericardial tamponade. The heart must first be relieved.
therapy
- symptomatic:
- hemodynamic stabilization, transfer to an intensive care unit
- Avoidance of bradycardia
- Avoid PEEP ventilation if possible
- causal (decompression):
- Relief by pericardial puncture , i.e. removal of the fluid from the pericardium , under ultrasound view; however, clotted blood cannot be punctured
- Pericardial fenestration
- Pericardiotomy (opening of the pericardium) with installation of a pericardial drainage (first performed by Larrey in 1810 ) or partial pericardectomy (removal of the pericardium)
- Thoracotomy (opening of the chest) with installation of a pericardial drainage and partial or complete pericardectomy
- Postoperative cardiac surgery patients (e.g. after valve or coronary bypass operations) often have a retrosternal drain, which in the acute situation can possibly be picked up or relieved with a suction device.
See also
literature
- H. Barth, A. Böhle et al .: Surgery (= dual series). 2nd Edition. Georg Thieme Verlag, Stuttgart 2003, ISBN 3-13-125292-8 , pp. 995-996.
Individual evidence
- ↑ Christoph Weißer: Heart surgery. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , pp. 583 f .; here: p. 583.
