Hemopericardia of the heart

One of the adverse effects of acute myocardial infarction is hemopericard - a dangerous and often occurring condition requiring urgent medical intervention. To this complication, the term "cardiac tamponade" is often used: for hemopericardium, the accumulation of blood in the pericardial cavity is characteristic - in the so-called pericardial bursa consisting of connective tissue.

The accumulated blood in the pericardium has a compressive effect, as a result of which it becomes difficult for the ventricles to perform their function. As a result - the development of acute insufficiency, shock and death.

[1], [2], [3], [4], [5],

Epidemiology

According to statistical data, hemopericard occurs in two people out of 10 thousand patients who have the above risk factors.

After the biopsy of the right ventricular endomyocardium, damage to the heart muscle occurs in 0.3-5% of patients, with less than 50% of cases developing hemopericardium. The incidence of lesions with left ventricular endomycard biopsy is estimated at 0.1-3%. The lethality after this procedure is no more than 0.05%.

After separation of the ascending aortic department, hemopericardia is fixed in 17-45% of cases.

[6], [7], [8], [9], [10], [11], [12]

Causes of the hemopericardium

The accumulation of blood in hemopericardia is observed not only because of a heart attack. There are traumatic and non-traumatic causes of pathology development. This allows you to divide the state of hemopericardium into separate types:

• travmogemperikard - is the result of direct physical damage to the structure of the heart;
• non-traumatic hemopericard - arises from other, indirect causes.

Traumatic hemostatic signs may occur:

• after severe chest injuries, chest or heart injuries;
• after any intracardiac manipulation ( puncture biopsy, injections, insertion of a catheter);
• after heart operations (CS installation, catheter ablation, mediastinotomy, poorly laid joints, etc.);
• after a sternal puncture.

A non-traumatic variety of hemopericardia arises:

• after left ventricular injury due to acute myocardial infarction;
• with the break of the coronary and coronary vascular walls;
• at rupture of an aneurysm of heart or an aorta;
• as a result of rupture of cardiac tissues against the background of an abscess, myocardial echinococcosis, gummous inflammation of the myocardium;
• with tumors of the heart;
• with increased bleeding due to hemorrhagic diathesis or hemophilia;
• after tubercular, purulent or idiopathic inflammation of the pericardium;
• when carrying out hemodialysis against a background of insufficient kidney function;
• for autoimmune diseases with connective tissue damage.

[13], [14], [15]

Risk factors

Any person is able to injure the chest in various circumstances. Trauma can be caused by direct injury (both knife and gunshot), bruise when falling from a height, compression of the chest. Extraordinary circumstances that can lead to the development of hemopericardia can be:

• earthquake disasters, floods, landslides, landslides;
• road accidents.

People who have certain problems with the heart and the nervous system are also at risk. The cause of hemopericardium is often the rupture of the vascular walls, acute myocardial infarction, myocarditis.

Other risk factors include:

• age over 50;
• bleeding disorders;
• vascular disease, angiosarcoma, lung and breast cancer;
• long-term radiation therapy;
• long-term use of such drugs as Minoxidil, Isoniazid, Hydralazine.

[16], [17], [18], [19], [20], [21]

Pathogenesis

The pericardial cavity, or the pericardial bursa, is formed from the parietal and visceral pericardial membranes. Between these shells is a cavity, which consists of separate sections (they are also called sinuses):

• forward sine;
• transverse sinus;
• oblique sine.

If the state of hemopericardium develops, the blood begins to accumulate inside the anterior section, located in the middle of the diaphragmatic and sternal-rib pericardial area.

[22], [23], [24], [25], [26]

Symptoms of the hemopericardium

Clinical symptoms of hemopericardia may be different, or not manifest at all: it depends on how much blood was in the pericardial cavity. If the blood volume is low, then the symptomatology may be absent.

Hemopericardium becomes apparent if the amount of the pericardial cavity is more than 150 ml. With such a volume, the heart experiences increased blood pressure, the blood circulation in it is disturbed, and the cardiac ejection decreases. In addition, arterial vessels that deliver blood to the myocardium can be squeezed.

The first signs of hemopericardia are conditionally divided into two categories - subjective and objective. Subjective attributes include:

• difficulty breathing;
• a feeling of anxiety and fear;
• nausea, general weakness;
• increased sweating.

Objective signs are:

• tachycardia;
• hypotension;
• impairment of pulse;
• cyanosis of the skin;
• a disorder of consciousness.

Often when listening to hard to determine the heart beat.

In addition, the patient can complain of pain behind the breastbone and a feeling of internal pressure in the chest. Visually, swelling of the cervical venous vessels is observed.

If a large volume of blood accumulates in the pericardial cavity (greater than 0.5 L), then cardiac arrest and death may occur. To prevent this, the patient must be treated with care and urgently.

Hemopericard with acute myocardial infarction occurs against the background of damage to the wall of the left ventricle - with the transmural form of the infarction. When a heart rupture, or aorta, within a few seconds, critical disorders of hemodynamics occur, resulting in a sudden clinical death.

Iatrogenic hemopericardia is often observed after percutaneous mitral valvuloplasty or transseptal puncture.

If the ventricles are damaged, the symptoms develop rapidly, and if the atria are damaged, clinical signs can appear only after about 5 hours.

[27], [28], [29],

Stages

Taking into account the peculiarities of hemopericardia, it is divided into stages:

• acute stage (lasts up to six weeks) - characterized by rapid development;
• chronic stage (lasts more than six weeks) - is formed gradually.

[30], [31]

Complications and consequences

With the expressed volume of blood poured into the pericardial bag, terminal circulatory disorders and sudden clinical death may occur . At the same time, measures for providing resuscitation help often become ineffective, since the amount of blood inside the pericardium can be 400-500 ml.

In the case when a heart or aortic vessel rupture occurs in a hospital, a lethal outcome can be established and its cause can be with a high degree of probability: electrocardiography fixes the sinus rhythm for a certain time. In some situations, with layered damage to an aneurysm, from the time of the first symptoms to the death of the patient, it can take a couple of hours, and several days.

Penetration of the myocardium is possible in the presence of an artificial pacemaker located in the right ventricle. One of the first symptoms is the appearance of a blockade of the right leg of the bundle.

[32], [33], [34], [35], [36]

Diagnostics of the hemopericardium

In addition to examining the patient, auscultatory listening to features of cardiac activity and tapping heart boundaries, additional types of studies are used to diagnose hemopericardia.

Blood tests are performed to evaluate the coagulation function, to determine the presence of an inflammatory process.

The analysis of urine is necessary for an estimation of working capacity of kidneys.

Instrumental diagnosis usually consists of such procedures:

• Electrocardiography: as a rule, shows a picture typical for effusion pericarditis, or high pointed teeth T in the thoracic leads.
• X-ray diagnosis indicates:
  • to increase the volume of the body;
  • on smoothed heart arcs;
  • on a reduced amplitude of pulsation, or its absence.

The X-ray needs to be carried out in dynamics: this will determine the rate of blood accumulation in the pericardial sac.

• The method of echocardiography demonstrates such pathological changes:
  • with a small hemopericardia, a relatively free echo gap is visualized in the interval between the posterior region of the pericardium and the posterior region of the left ventricular epicardium;
  • with significant hemopericardia, this lumen is localized between the anterior portion of the right ventricular pericardium and the parietal portion of the pericardium below the anterior thoracic wall;
  • with expressed hemopericardia, the heart often oscillates in the cavity of the pericardium sac: sometimes such a vibration can lead to a breakdown in the electrical functionality of the organ.
• The method of angiocardiography involves the introduction of contrast into the cavity of the right atrium. This allows us to consider the separation of the lateral wall from the border of the silhouette of the heart.

[37], [38], [39], [40]

Differential diagnosis

Differential diagnosis of hemopericardia is carried out with such pathological conditions as exudative pericarditis, hydropericardium, as well as with other hemopericarditis of non-inflammatory etiology.

Treatment of the hemopericardium

With a small accumulation of blood in the pericardial bursa, the patient is prescribed medication, against a background of mandatory bed rest, and also provides peace and a balanced diet. To the area of the chest at first apply a cold compress.

If necessary, with hemopericardium, the doctor prescribes hemostatic therapies and medications to support the performance of the cardiovascular system.

Individual patients may be prescribed anti-inflammatory and antibacterial drugs (if the infectious component of the pathology is diagnosed).

During the entire course of treatment, hemodynamic parameters are necessarily monitored. If the patient's condition is assessed as stable, then follow-up medical tactics should be directed at eliminating the cause of hemopericardia.

If the blood continues to accumulate in the pericardial bag, the doctor decides to stop the medication and start a surgical procedure.

Medications that can be used for hemopericardium

To eliminate pain, 1 ml of 1% morphine, 2 ml of 2% promedol, 2 ml of 2% pantopone in the form of subcutaneous or intravenous injection are administered to the patient.

An intravenous analgesic mixture is administered, inhalation of nitrous oxide and oxygen is used.

Under no circumstances should hemomedicard be administered drugs that can lower blood pressure (eg, aminazine), as well as heparin-based medications that increase bleeding.

After pericardial puncture, if necessary, an antibiotic is injected through the needle - for example, penicillin 300,000 units.

After puncture, the doctor prescribes anti-inflammatory therapy, with the use of corticosteroid drugs and non-steroidal anti-inflammatory drugs. Intrapericardial administration of corticosteroids is considered more effective and helps to avoid the side effects that are possible with the systemic application of these drugs.

Against the background of a gradual decrease in the dosage of prednisolone, the administration of ibuprofen or colchicine, at individual dosages, is started as soon as possible.

The recommended dose of colchicine can be 2 mg per day for 1-2 days, then 1 mg per day.

The recommended dose of prednisolone is 1-1.5 mg per kg, for 4 weeks. Treatment with corticosteroids ends gradually, slowly lowering the dosage.

Selection of hemostatic drugs and their dosage are performed strictly individually, depending on the cause and peculiarities of the course of hemopericardium.

Vitamins

What vitamins are needed for the heart after the transferred hemopericardium? How to relieve heart function?

• Vitamin E is a powerful antioxidant that strengthens the vascular walls /
• B-group vitamins - normalize metabolic processes and cholesterol level.
• Omega-3 acids - prevent the development of atherosclerosis, improve the elasticity of blood vessels.
• Coenzyme Q ₁₀  - improves cellular metabolism and respiration, optimizes myocardial contractility, speeds up energy metabolism.

After hemopericardium, special attention should be given to nutrition. It should be high-grade, and at the same time low-calorie, because getting rid of excess kilograms will reduce the burden on the heart. It is useful to enrich the diet with such food as fish, beans, olive oil, vegetables and fruits.

Physiotherapeutic treatment

Therapeutic physical training and massage are the main procedures for the recovery of patients after hemopericardium. Moderate and correctly selected physical exertion will strengthen myocardium and coronary vessels, as well as prevent the likelihood of repeated pathology.

First, slow walking along the corridor is allowed for a quarter of an hour. In this case, the doctor must necessarily measure the pulse rate and blood pressure indicators.

Little by little, climbing and descending the stairs, as well as uncomplicated gymnastic movements and massage, are attached to the walk. When there is pain in the chest, shortness of breath and instability of pressure, the exercises are made less intense.

After discharge of the patient from the hospital, the lessons continue, gradually increasing the load. It must be understood that the myocardium needs regular training. An exception is the presence of an aneurysm. The loads in this case are contraindicated.

Alternative treatment

Alternative medicine often helps even in very severe cases. However, with hemopericarde, alternative recipes can be used only at the stage of recovery, and only after consulting a doctor - a puncture alternative means will not be replaced.

For the regeneration of damaged tissues after the condition of hemopericardium and for improving the work of the heart, alternative healers offer such popular recipes:

1. Prepare a healing gruel from the same parts of ground kernels of walnut and honey. To prevent complications, you need to eat every day for 50-70 g of this mass.
2. Mix 100 ml of aloe vera juice and 200 ml of lime honey, add 200 ml of quality Cahors. Take 1 tsp. The product received before each meal.
3. Lemon is peeled and passed through the meat grinder along with the peel. After this, the resulting mass is mixed with ground kernels from apricot kernels, with grated pelargonium and honey (0.5 liters). Use the remedy up to 4 times a day, before eating 1 tbsp. L.
4. Two parts of the anise seeds are mixed with one part of the ground valerian root, one part of the crushed yarrow and lemon balm leaves. One tablespoon of the mixture is poured into 200 ml of boiling water and insisted for half an hour. The received drug is drunk two or three times.

[41], [42], [43], [44], [45], [46], [47], [48]

Herbal Treatment

With hemopericardium, it is very important to properly maintain cardiac function and strengthen the body's resistance. An excellent tool for these purposes will be medicinal plants.

• Juice from the dense leaves of mother-and-stepmother should be drunk at least four times a day, at 1-2 tbsp. L. Healers argue that even one treatment course per year is enough to strengthen the body. On average, this course can last for 1-2 weeks.
• To prevent complications from the heart prepare an equilibrium mixture of plants such as mother-and-stepmother, lime flower, willow bark, raspberry and anise. One tablespoon of the dry mixture is brewed in 400 ml of boiling water, insisted in a thermos for about half an hour, then filtered and drunk instead of tea, at any time of the day.
• Mix in the same amount of field horsetail, the color of black elderberry and the rhizome of the althaea. Brew for the night in a thermos at the rate of 2 tbsp. L. Collection of 500 ml of boiling water. Infusion take 100 ml 2-3 times a day.
• Prepare a mixture of one part of chamomile, three parts of hawthorn, motherwort and cudweed. Pour 1 tbsp. L. Mixture of 400 ml of boiling water, insist for eight hours. Take 100 ml 3-4 times a day between meals.

Homeopathy

Doctors-homeopaths advise to apply homeopathic treatment practically at any diseases which do not require an emergency surgical intervention. Hemopericard is a serious and dangerous condition, in which one can not rely solely on homeopathy: urgent intervention and emergency medical care is needed.

At the stage of recovery after hemopericardine, against the background of drug treatment, individual homeopathic preparations are allowed, at the doctor's discretion. For example, the following means of homeopathy are possible:

• The goal is to restore soft tissues, one tablet three times a day.
• Traumeel - take one tablet three times a day, for a long time (at the discretion of the doctor).
• Nuks vomica-homaccord - take 30 drops per day, in 100 ml of water, 15-20 minutes before meals.
• Berberis gommakord - take 10 drops three times a day, 15-20 minutes before meals, with water.
• Belladonna gommakord - take 10 drops 3 times a day, 15 minutes before meals.

Homeopathic remedies in rare cases can cause allergic reactions: this must be taken into account if the drug is taken for the first time.

Surgery

If the heart or vascular walls are damaged, an emergency operation is performed in order to eliminate the root cause of the release of blood into the pericardium. This is an operation of thoracotomy and suturing of damaged tissues.

The type and nature of the operation with hemopericardium is determined by the doctor, depending on the complexity of the lesion.

With the rapid development of hemopericardia, it is necessary to urgently eliminate excess pressure on the heart and remove the spilled blood. To this end, they carry out:

• pericardial puncture (operation pericardiocentesis ) when injected into the pericardial suction needle and the aspirated blood izlivshuyusya;
• operative drainage of the pericardial sac (puncture and install a drainage catheter in the area of the maximum accumulation of blood);
• percutaneous balloon pericardiotomy (a special balloon is inserted inside the pericardial bag providing a window for the withdrawal of blood).

Minimally invasive operations are performed under ECG monitoring and echocardiography, with mandatory background monitoring of hemodynamic function.

With a large blood loss to restore the homeostatic balance, the patient may be prescribed oxygen therapy, the introduction of plasma substitutes and other solutions.

After stopping the release of blood into the pericardium, the first cause of hemopericardium is administered.

Prevention

Prevention of hemopericardia is to prevent and prevent situations that can cause the development of hemopericardium:

• prevention of chest area injuries;
• prevention of diseases of the cardiovascular system, blood diseases;
• prevention and timely treatment of infectious diseases.

It is necessary to be systematically examined by doctors, including a cardiologist, and also to contact the doctor in time for the slightest signs of deterioration of well-being.

[49], [50], [51], [52], [53], [54], [55],

Forecast

The prognosis of hemopericardium mainly depends on the amount of blood in the pericardial cavity, as well as on how quickly the tamponade occurs, and how timely the treatment was provided.

In the chronic form of the disease, it is important to correctly treat the underlying cause of hemopericard: this will stop the further release of blood into the pericardial bursa.

The most negative prognosis is acute hemopericard: if 400 ml of blood accumulate in the cavity and more, then the death of the patient occurs.

Timely surgical intervention increases the likelihood of a favorable outcome. The statistics confirm: if the puncture is carried out on time, the patient's chances of survival increase by 95-100%. Therefore it is very important not to hesitate at the slightest suspicion of hemopericardium.

[56], [57]