Pericardial effusion

Introduction to pericardial effusion Pericardial effusion is a more common clinical manifestation, especially after echocardiography becomes a routine examination of cardiovascular disease, the detection rate of pericardial effusion in patients is significantly increased, up to 8.4%, most of the pericardial volume The fluid does not appear clinically due to the small amount. A small number of patients have a prominent clinical manifestation with pericardial effusion due to a large amount of fluid. When the pericardial effusion lasts for more than a few months, it constitutes a chronic pericardial effusion. There are many causes of chronic pericardial effusion, most of which are related to diseases that can affect the pericardium. basic knowledge The proportion of patients: the incidence of pericardial effusion in patients with malignant tumors is 3% Susceptible people: no specific population Mode of infection: non-infectious Complications: Infective endocarditis Heart failure

Causes of pericardial effusion

The common causes of pericardial effusion are divided into two categories: infectious and non-infective.

Non-infectious (30%):

Including tumors (especially lung cancer, breast cancer, lymphoma, mediastinal tumors, etc.), rheumatism (rheumatoid arthritis, systemic lupus erythematosus, scleroderma, etc.), heart damage or large blood vessel rupture, endocrine and metabolic diseases (such as Hypothyroidism, uremia, gout, etc.), radiation damage, effusion after myocardial infarction, etc.

Infectivity (30%):

Including tuberculosis, viruses (Coxsackie, flu and other viruses), bacteria (S. aureus, pneumococci, Gram-negative bacilli, molds, etc.), protozoa (ameba), etc.; most pericardial effusions are stubborn and difficult to treat, difficult Complete eradication, clear cause, treatment of the disease itself, can relieve or cure the pericardial effusion.

Pericardial effusion prevention

Pericardial effusion is mostly chronic pericardial effusion, because long-term self-care is needed to prevent early prevention. Pericardial effusion is a disease caused by the accumulation of long-term habits. So it is important to develop good habits.

as follows:

1. Develop good habits and not smoke.

2, maintain a good attitude, stable mood, have healthy eating habits, usually eat more fruits and vegetables, etc., improve self-immunity.

3, must work in heavy smoke, try to protect yourself, such as wearing a mask, regularly go out to breathe some fresh air, at least once a year to check.

4, away from smoke, alcohol, drugs, radiation, pesticides, noise, volatile harmful gases, toxic and harmful heavy metals.

Pericardial effusion complications Complications Infective endocarditis heart failure

Pericardial effusions often exist as complications of other diseases, such as tumors, heart failure, rheumatism, etc., and the complications caused by this disease have the following complications in addition to the compression symptoms of the lungs:

1. Cerebral hemorrhage

Pericardial effusion complicated with cerebral hemorrhage is less reported, and its occurrence may be related to a large amount of pericardial effusion, blood flow to the heart is blocked, and intracranial intravascular pressure is increased, which is related to vascular rupture. Therefore, other accompanying symptoms should be strictly observed during treatment. If there are some symptoms that are difficult to explain with this disease, you should actively look for other diseases to avoid missed diagnosis and timely treatment.

2, infective endocarditis

The premise of this disease is because the pericardial effusion contains purulent cells. When infected endocarditis occurs, due to the valve involvement, the exuded fibrin and white blood cells and bacteria can form neoplasms attached to the affected valve. In echocardiography, the reflected echoes formed by such neoplasms are characteristic features of echocardiography. On two-dimensional ultrasound, the size, shape, attachment position, and activity of the neoplasms can be clearly seen. Therefore, the detection of sputum organisms is extremely helpful for the diagnosis of infective endocarditis by ultrasound.

Symptoms of pericardial effusion Common symptoms, shortness of breath, pre-cardiac area, pain, shortness of breath, chest pain

The patients with this disease are more common in women, and the age of onset is more than menopause. Patients often participate in daily work without conscious discomfort. When symptoms appear, they often show shortness of breath and chest pain. Some patients have symptoms of pericardial occlusion early in the course of the disease, and The progress of the disease has gradually slowed down or even disappeared. Many of the diseases were found during routine physical examination, and were easily misdiagnosed as enlarged heart. Because there is almost no history of acute pericarditis, it is often impossible to determine the time of the disease. The disease has good hemodynamic tolerance. As the pericardial effusion is gradually increased, the pericardial volume has a certain adaptation to the increase of effusion, which makes the accumulation of a large amount of pericardial effusion only cause mild pericardial pressure increase. , manifested as unrestricted pericardial effusion, so pericardial occlusion has little or no occurrence, only when the pericardial effusion suddenly increases sharply, the adaptive expansion of the pericardium is lower than the increase of effusion, which is characterized by restrictive pericardial effusion, It is possible that there is a pericardial occlusion, and there has been a report that the pericardial effusion disappeared on its own, but since this may be related to the cause treatment, it is chronic Whether there will go away effusion can not be determined when the onset of pericardial effusion.

The disease still lacks a precise and uniform definition, and is generally classified into the disease by those who meet the following characteristics:

1. There is a large amount of pericardial effusion, which has been confirmed by UCG.

2. The amount of pericardial effusion remained basically stable during the observation period.

3, pericardial effusion persists for at least 3 months.

4. The patient has been excluded from any systemic disease, regardless of whether the disease may be associated with pericardial effusion.

5, the system's etiological examination is negative, this disease is sometimes called "chronic exudative pericarditis", "chronic idiopathic pericarditis", but because in most cases patients do not have pericarditis performance, These naming are gradually avoided, and the incidence of this disease in pericardial diseases is about 2% to 3.5%.

Examination of pericardial effusion

1. X-ray examination: the heart shadow is generally enlarged to both sides (more than 300 ml of effusion); when the effusion (more than 1000 ml), the heart shadow is in the form of a flask, the shadow of the superior vena cava is widened, and the heart beats weakly under the fluoroscopy. Wild clarity can be distinguished from heart failure.

2, ECG: often have low voltage, tachycardia, a large number of fluids, visible voltage alternating.

3. Echocardiography: M-mode ultrasound has a liquid dark area between the anterior wall of the heart and the posterior wall of the heart, that is, the maximum diastolic dark area between the pericardium and the epicardium (10 mm, then effusion) It is a small amount; if it is between 10-19 mm, it is a medium amount; if it is more than 20 mm, it is a large amount).

4, pericardial puncture: can confirm the presence of pericardial effusion, relieve the symptoms of pericardial tamponade, and retain part of the effusion for laboratory tests of related causes.

Diagnosis and differentiation of pericardial effusion

diagnosis

Clinically, the chest shadow is enlarged by routine X-ray examination. After UCG and systemic examination, as well as etiological examination, specific diseases such as tuberculous pericarditis and rheumatic pericarditis can be diagnosed.

Differential diagnosis

Need to identify with specific lesions such as tuberculous pericarditis, rheumatic pericarditis and other diseases.

1. Tuberculous pericarditis

Common symptoms are fever, chest pain, cough and difficulty in breathing. Pericardial tamponade or constrictive pericarditis may show increased peripheral venous blood circulation, such as edema, ascites, etc., signs of increased heart sounds, heart sounds distant, pericardium Friction sound, tachycardia, etc., some patients have atypical clinical manifestations, insidious onset, no symptoms of tuberculosis poisoning, diagnosis based mainly on clinical manifestations, pericardial effusion examination and tuberculosis history, tuberculosis examination and culture positive examination in pericardial effusion The outflow rate is not high, only 60% of patients in the OT trial are moderately positive or strongly positive, and pericardial effusion culture takes 4-6 weeks. Pericardial biopsy is difficult to implement. Recent PCR tests can improve the positive rate of diagnosis, echocardiography. The examination is non-specific, but the amount of pericardial effusion can be determined, and the pericardium is thickened or thickened, which provides valuable reference materials for the diagnosis of the cause, and can evaluate the curative effect. The X-ray can be seen to enlarge the heart to both sides, and the electrocardiogram can be There are QRS complex low voltage and T wave inversion. Some patients need to be treated according to the treatment results. In recent years, magnetic resonance imaging technology can also be used to understand the pericardium. The extent of effusion provides the basis.

2, rheumatic pericarditis

It is a part of rheumatic whole heart disease. It is more common in adolescents. In rheumatism, the pericardium is almost always involved, but clinically, only 15% of rheumatic pericarditis cases have been diagnosed. The lesions mainly involve the pericardium. It is serous or serous cellulose inflammation, epicardial connective tissue can undergo cellulose-like degeneration, a large amount of serous exudation (pericardial effusion) can be found in the pericardial cavity, the pericardial heart is extended to the left and right, and the heart sound is distant during auscultation. X-ray examination, the heart is pear-shaped, when a large amount of fibrin oozes out, the cellulose on the epicardial surface is fluffy due to the heart's constant pulsation, called cor villosum, during the recovery period, the serum is gradually Absorption, most of the cellulose is dissolved and absorbed, a small part of the mechanization, resulting in pericardial viscera, partial adhesion of the two layers of the wall, very few cases can be completely more, forming constrictive pericarditis (consrictive pericarditis).

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