Cardiac tamponade signs
Introduction
Introduction The main signs of cardiac tamponade are: 1. Jugular vein engorgement, abnormal venous pressure. 2, blood pressure drops, pulse pressure is reduced, severe cases can cause shock. 3, odd pulse. 4, heart sounds weak, far away. 5, difficulty breathing, sitting and breathing, leaning forward, accompanied by hairpins.
Cause
Cause
In the past, common diseases were due to rheumatic fever, tuberculosis and bacterial infections. In recent years, the incidence of viral infections, tumors, and myocardial infarctitis has increased significantly.
Examine
an examination
Related inspection
Dynamic electrocardiogram (Holter monitoring) ECG
1, laboratory inspection
Depending on the primary disease, infectious people often have inflammatory reactions such as increased white blood cell count and increased erythrocyte sedimentation rate.
2, X-ray inspection
It has little value in the diagnosis of fibrinous pericarditis, and has certain value for exudative pericarditis. It can be seen that the heart shadow increases to both sides, and the heart beats weakly or disappears; especially the lung has no obvious congestion and the heart shadow increases significantly. It is a strong evidence of pericardial effusion, which can be distinguished from heart failure. When the adult fluid volume is less than 250 ml and the child is less than 150 ml, it is difficult to detect the effusion on the X-ray.
3, ECG
The pericardium itself does not produce electrodynamic power. The abnormal electrocardiogram in acute pericarditis comes from the myocardium under the pericardium. The main manifestations are: 1ST segment elevation, which is seen in all conventional leads except the aVR lead, which is arched down, aVR ST segment depression in the middle of the joint; 2 one to several days later, ST segment returned to the baseline, T wave low level and inverted, T wave gradually returned to normal after several weeks to several months; 3 pericardial effusion with QRS low voltage, a large amount of fluid When there is electrical alternation; 4 no pathological Q wave, no QT interval prolongation; 5 often have sinus tachycardia.
4, echocardiography
It is simple and easy to diagnose and diagnose pericardial effusion. Liquid dark areas can be seen in M-mode or two-dimensional echocardiography to determine the diagnosis. It can be checked repeatedly to observe changes in the amount of pericardial effusion.
5, pericardial puncture
It can confirm the presence of cardiac effusion and check the extracted liquid for biological (bacterial, fungal, etc.), biochemical, cell classification, including the search for tumor cells, etc.; taking a certain amount of effusion can also relieve the symptoms of cardiac tamponade; If necessary, an antibacterial or chemotherapeutic drug may be injected into the pericardial cavity by puncture. The main indications for cardiac puncture are cardiac tamponade and exudative pericarditis of unknown etiology.
6, pericardial biopsy
Helps to clarify the cause.
Diagnosis
Differential diagnosis
Pericardial fluid sign: The apex beat is weak or inaccessible. If it can be touched, it is inside the left border of the heart sound. The heart is enlarged to the sides, and the dullness of the heart is widened in the lying position, and the heart sound is low and distant. When a large amount of fluid is accumulated, voiced and bronchial breath sounds may appear in the area under the left scapula, called the Ewart sign.
Pericardial tamponade: The pericardial cavity is the space between the parietal pericardium and the visceral pericardium on the surface of the heart. A small amount of light yellow liquid in the normal pericardial cavity lubricates the surface of the heart. Traumatic heart rupture or pericardial vascular injury caused by blood accumulation in the pericardial cavity called blood pericardial or pericardial tamponade, which is the cause of rapid death of cardiac trauma. M-mode ultrasound showed the ventricle activity curve of the pericardium. When the pericardial tamponade, the direction of the anterior wall of the right ventricle changed, and the diastolic phase showed a centripetal movement, that is, the posterior displacement.
Pericardial tamponade: also known as pericardial tamponade, venous blood can not be refluxed, can appear hepatomegaly, ascites, lower extremity edema and other symptoms of blood stasis, of course, the heart blood is also reduced, blood pressure is reduced, blood supply is incomplete. In patients with closed chest injury, where: (1) elevated venous pressure; (2) weak heartbeat, distant heart sound; (3) decreased arterial pressure. Suspected of pericardial tamponade, can be pericardial puncture under the left rib arch under the xiphoid process, such as pumping out blood, you can confirm the diagnosis. Two-dimensional echocardiography can also determine the diagnosis of pericardial hemorrhage.
Cardiac deposit amyloid: A disease in which myocardial dysfunction caused by amyloid protein deposition in myocardial tissue. Echocardiography, the main performance: 1 in addition to the left or lower ventricular internal diameter is normal or small, the ventricular cavity is enlarged; 2 room interval and ventricular wall thickening, and symmetry; 3 atrioventricular valve or papillary muscle can also be affected by the lesion Thickening or thickening; 4 about half of the pericardial effusion; 5 about 92% of patients thickened in the myocardium visible scattered circular or irregular strong reflection small spots, which is a characteristic manifestation of the disease. In order to better recognize this kind of light spot, the long axis view and the short axis view of the sternum are generally taken, instead of taking the apical four-chamber view. It is believed that this strong reflection small spot is caused by nodules formed by colloidal and amyloid tissue.
Cardiopulmonary embolism: can cause changes in cardiopulmonary function, the degree of change depends on the extent of pulmonary occlusion, speed, original cardiopulmonary function status. Light heart and lung function can be no significant changes, severe cases can lead to hypoxemia, hypocapnia, alkaliemia, increased pulmonary circulation resistance, pulmonary hypertension, acute right ventricular dysfunction. X-ray examination can show typical signs such as patchy infiltration, atelectasis, and diaphragmatic elevation. Generally speaking, when pulmonary vascular bed obstruction is >30%, the mean pulmonary artery pressure starts to rise, and when the right atrial pressure is increased by >35%, the pulmonary vascular bed loss is >50%, which can cause a significant increase in pulmonary artery pressure and pulmonary vascular resistance. Reduced and acute pulmonary heart disease. Repeated pulmonary embolism produces persistent pulmonary hypertension and chronic pulmonary heart disease. In patients with impaired cardiopulmonary function, the hemodynamic effects of pulmonary embolism are far more prominent than the usual patients.
1, laboratory inspection
Depending on the primary disease, infectious people often have inflammatory reactions such as increased white blood cell count and increased erythrocyte sedimentation rate.
2, X-ray inspection
It has little value in the diagnosis of fibrinous pericarditis, and has certain value for exudative pericarditis. It can be seen that the heart shadow increases to both sides, and the heart beats weakly or disappears; especially the lung has no obvious congestion and the heart shadow increases significantly. It is a strong evidence of pericardial effusion, which can be distinguished from heart failure. When the adult fluid volume is less than 250 ml and the child is less than 150 ml, it is difficult to detect the effusion on the X-ray.
3, ECG
The pericardium itself does not produce electrodynamic power. The abnormal electrocardiogram in acute pericarditis comes from the myocardium under the pericardium. The main manifestations are: 1ST segment elevation, which is seen in all conventional leads except the aVR lead, which is arched down, aVR ST segment depression in the middle of the joint; 2 one to several days later, ST segment returned to the baseline, T wave low level and inverted, T wave gradually returned to normal after several weeks to several months; 3 pericardial effusion with QRS low voltage, a large amount of fluid When there is electrical alternation; 4 no pathological Q wave, no QT interval prolongation; 5 often have sinus tachycardia.
4, echocardiography
It is simple and easy to diagnose and diagnose pericardial effusion. Liquid dark areas can be seen in M-mode or two-dimensional echocardiography to determine the diagnosis. It can be checked repeatedly to observe changes in the amount of pericardial effusion.
5, pericardial puncture
It can confirm the presence of cardiac effusion and check the extracted liquid for biological (bacterial, fungal, etc.), biochemical, cell classification, including the search for tumor cells, etc.; taking a certain amount of effusion can also relieve the symptoms of cardiac tamponade; If necessary, an antibacterial or chemotherapeutic drug may be injected into the pericardial cavity by puncture. The main indications for cardiac puncture are cardiac tamponade and exudative pericarditis of unknown etiology.
6, pericardial biopsy
Helps to clarify the cause.
