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Posted by Specialist Doctor II Nguyen Bang Phong - Internal Medicine - Cardiovascular Intervention cum Head of Heart Failure Clinic - Heart Failure Intensive Care Clinic - Vinmec Times City International Hospital
There are many causes of pericardial effusion, the disease can occur from pericarditis when there is damage or disease in the heart. Sometimes, the flow of fluid in the pericardium is blocked or blood is blocked in this membrane due to trauma to the chest, thereby causing fluid retention. In some cases, the cause of pericardial effusion is unknown, as in idiopathic pericarditis.
1. Anatomical structure of pericardium
The anatomical structure of the pericardium consists of 2 layers: the inner layer is close to the heart muscle called the visceral leaf, the outer layer is close to the chest wall - the mediastinum is called the parietal leaf. Normally between the two layers is a virtual cavity, with a thin layer of fluid (about 10-15 ml). Depending on the amount and rate of fluid formation, we have a corresponding clinical picture, from mild - no symptoms to severe - cardiac tamponade. Pericardial fluid can be blood, permeable fluid, or exudate.
Hình ảnh tràn dịch ngoài màng tim trên X-quang
2. Causes of pericardial hemothorax
Causes of trauma, wounds: often cause acute cardiac compression due to rapid blood flow, pericardium has not yet dilated.
Concussion, pressure trauma that tears or ruptures the heart wall or large blood vessels at the connection point to the heart. Wounds caused by sharp, sharp objects, by bullets that tear or puncture the heart wall, coronary artery or large blood vessels at the connection point to the heart. This group of causes includes a perforation of the myocardium or coronary artery during a previous pericardiocentesis, or during a pacemaker procedure. Aortic dissection, usually type A: often causes acute cardiac tamponade due to rapid blood flow, pericardium has not yet dilated.
In addition, spontaneous pericardial bleeding is also caused by the use of anticoagulants. Pericardial hemorrhage due to cancer, tuberculosis.
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3. Causes of exudative pericardial effusion
There is a lot of protein in the fluid (> 30 g/l – positive Rivalta test). In addition, depending on the cause, there may be white blood cells, red blood cells, fibrin, and cancer cells in the fluid.
Causes of exudate in the pericardium include:
Cancer: rarely due to primary cancer from the pericardium, but often from metastases from other organs. Usually red fluid, quite a lot, causing chronic cardiac tamponade, rapid recurrence. Tuberculosis: the fluid is usually red, rich in protein and fibrin, and lymphocytes. Determine the presence of TB bacteria by culturing the fluid with Lowenstein's medium or doing PCR. Purulent pericarditis: an infectious disease. The fluid is rich in protein, often cloudy due to the presence of many white blood cells, bacterial corpses, and bacteria are often grown in culture. If caused by staphylococcus aureus, it is usually very severe, or there is acute cardiac tamponade even though the amount of fluid is not much. Purulent pericarditis can be caused by primary, bacteremia, or by rupture of adjacent abscesses such as liver abscess, lung abscess, or subdiaphragmatic abscess. Some other causes of exudate in the pericardium include systemic diseases, fungi, lymphatic fistulas, especially thoracic duct fistulas.
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4. Pericardial fluid due to permeation
Due to increased hydrostatic pressure when circulation stagnates, or colloidal pressure decreases, leading to drainage of fluid from the lumen into membranes, including the pericardium. Low protein: < 30 g/l, negative Rivalta test, may have a negligible amount of cells. Pericardial effusion due to permeable fluid is usually small in number, rarely causing acute cardiac tamponade.
Due to increased hydrostatic pressure as in heart failure, renal failure, central venous occlusion, lymphatic system occlusion. Due to decreased oncotic pressure (albumin deficiency): nephrotic syndrome, cirrhosis, hypothyroidism. Treatment for a pericardial effusion will depend on how severe the effusion is, the cause of the effusion, the potential for complications, and the patient's general health. core.
Bệnh viện Đa khoa Quốc tế Vinmec là địa chỉ tin cậy giúp khách hàng sàng lọc tim mạch
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