Intrapericardial hemorrhage

Introduction Internal bleeding can occur in any part of the body, blood accumulation in the body cavity is called body cavity blood, such as abdominal blood, pericardial hemorrhage. After pericardial vascular or cardiac injury, such as small amount of bleeding, slow speed does not produce cardiac tamponade symptoms, known as pericardial hemorrhage, due to the presence of fibrous layer entrapment, the presence of concentrated blood components and body fluids, suggesting pericardium Internal bleeding is an important factor in the formation of pericardial constriction. Constrictive pericarditis is the end result of certain pericardial diseases. Pericardial fibrosis, calcification, and thickening cause the pericardial constriction, compression, and restriction of heart relaxation.

Cause

Because it is often found that the outer fibrous layer is wrapped, the inner part is concentrated in blood components and body fluids, suggesting that pericardial hemorrhage is an important factor in the formation of pericardial constriction.

1. Damage caused by high-speed foreign objects: High-speed foreign objects usually refer to high-speed and sharp foreign objects such as bullets, shrapnel, and sharp knives that penetrate the chest wall and cause pericardium and heart. This is especially common in wartime and is common in peacetime. This type of injury often coincides with chest and abdominal trauma.

2. Damage caused by violent inward displacement of the sternum or rib fracture end: mostly caused by traffic accidents or industrial accidents.

3. Cardiac damage caused by other causes: cardiac catheterization, interventional cardiac therapy, pericardial puncture and esophageal foreign body.

an examination

Related inspection

Thoracic fluoroscopy cardiovascular MRI coronary angiography

The heart has a large wound, the pericardial wound is small or the blood clots are blocked around the wound. Acute pericardial hemorrhage 100 ~ 200ml can make the pressure in the pericardial cavity rise sharply, and affect the normal relaxation of the heart, resulting in acute pericardial tamponade. The first to be compressed is the vena cava and atrium, causing an increase in central venous pressure and end-diastolic pressure, which gradually increases the venous pressure of the body. At first, due to the reflex contraction of the surrounding blood vessels, the blood pressure is normal or slightly higher. When the diastolic heart is severely restricted, the stroke volume per stroke is significantly reduced, and the arterial pressure drops rapidly. When the pressure in the pericardial cavity rises to 17cmH2O, the heart beats without blood, unless the rapid rehydration increases the venous pressure, otherwise the patient quickly enters the shock symptoms.

Differential diagnosis

On the one hand, acute cardiac tamponade reduces the amount of cardiac output, affects the blood supply to the coronary arteries, leads to myocardial hypoxia, sudden decompensation of cardiac function, and failure. On the other hand, pericardial tamponade can delay the lethal bleeding in the early stage, or temporarily stop the myocardial rupture, which provides valuable time for the rescue of the patient's life.

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