Pericardial Effusion, Post-Pericardiotomy Syndrome, uye Medical Tamponade¶

Medical cardiac tamponade injodzi yehupenyu inovharidzira yemoyo nekukurumidzira umo ropa, mvura inoputika, kana kuputika kwakashata kunoungana mukati meinelastic fibrous sac yakatenderedza moyo (pericardium), ichisvina makamuri emwoyo kubva kunze kuti isakwanise kuzadza neropa pakati pekurohwa. Kusiyana nekupinda muchipfuva trauma (yakafukidzwa mukati cardiac tamponade uye inopinda mukati mechipfuva), kwete-traumatic tamponade inokura kwemaawa, mazuva, kana mavhiki mushure mekuvhiyiwa kwemoyo, pacemaker kana catheter ablation maitiro, kenza, kutadza kweitsvo, kana acute viral pericarditis. Kana mumwe munhu akawedzera kupfupika kwekufema paanenge akarara, tsinga dzemutsipa dzakaputika, kuchena musoro, kana kudonha kweropa, fonera nzvimbo yako. nhamba dze emergency pakarepo. Paunenge wakamirira vanobatsira varwere, dzokorora nhungamiro ine hukama pa pericarditis uye myocarditis, pacemaker uye ICD mudziyo matambudziko,uye kuzivikanwa kwekuvhunduka uye rubatsiro rwekutanga.

Nokuti mwoyo wakamanikidzwa nemvura mukati mayo pericardial sac unovimba zvachose nepamusoro-soro yekuzadza venous uye kukurumidza kwemoyo kuti ropa rirambe richitenderera kuuropi, kupona kusati kwapera chipatara chekukurumidzira (** pericardiocentesis **) kunoenderana nekubvumira murwere kuti agare akatwasuka akasendamira mberi, kudzivisa kushanda kusingakoshi kwemuviri, kusambopa diuretics, kusambopa diuretic. uye kuzivisa vabatsiri nekukurumidza kana murwere achangobva kuvhiyiwa chero moyo kana catheter maitiro.

Ita izvi ikozvino¶

1. Fonera nhamba yako ye emergency nekukurumidza. Dhonza 911 muUnited States neCanada, 112 muEuropean Union, 999 muUnited Kingdom, 000 kuAustralia, kana bvunza dhairekitori redu re nhamba dze emergency. Taurira mutumwa zvakajeka: * "Inofungidzirwa cardiac tamponade / pericardial effusion: kupfupika kwakanyanya, mitsipa yemutsipa yakasununguka, kuderera kweropa, uye maitiro emwoyo achangobva kuitika (kana kenza / pericarditis nhoroondo)."
2. Rega murwere agare akati twasu uye akazendamira mberi zvishoma (kana kuti azorore munzvimbo yake yakanyatsogadzikana). Usambomanikidza murwere anofungidzirwa kuti pericardial effusion kana tamponade kurara pasi nemanhede kana ari kunetseka kufema (orthopnea). Kugara wakatwasanuka uye wakazendamira mberi papiro kana tafura yakavharika (thetripod kana kuti Mohammedan munamato chinzvimbo) kunokwevera moyo mberi uye kunobvumira mvura kuti iungane pazasi pe pericardial sac, kurerutsira chipfuva uye basa rekufema. Kana murwere achinzwa kupera simba kubva mukuderera kweBP, mutsigire semi-up pa 30 kusvika 45 madhigirii nemakumbo avo akatsigira akachinjika.
3. *usambopa nitroglycerin (glyceryl trinitrate), furosemide (mapiritsi emvura), kana mamwe mapiritsi eBP. Varwere vane cardiac tamponade vanowanzova nechipfuva chakazara uye tsinga dzemutsipa dzakazvimba izvo nhengo dzemhuri dzinokanganisa nokuda kweangina kana kuti mvura yakawandisa yemwoyo isingafadzike. Kupa nitroglycerin kana kuti diuretic kunoparura tsinga uye kunobvisa high venous pressure irikumanikidza ropa kupinda murutivi rwerudyi rwakadzvanywa rwemoyo, zvichikonzera kuparara kwemoyo nekukasika.
4. Misa mishonga yose inoderedza ropa yakanyorwa nemishonga (anticoagulants) uye USApa aspirin. Kana munhu akatora apixaban, rivaroxaban, dabigatran, warfarin, kana clopidogrel (iyo inowanzoshandiswa mushure meatrial fibrillation ablation, stent placement, kana kuvhiyiwa kwevharuvhu), usape muyero unotevera uye usambofa wakaiswa ma aspirin akawanda. hemorrhagic bleeds mu pericardial sac (**hemopericardium **) inoda kuchinjwa kwechipatara.
5. Ongorora BP uye pulse rate kana chitarisi chepamba chiripo, uye ona chero kudonha kukuru panguva yekufema (pulsus paradoxus). Rekodha systolic nediastolic blood pressure (kutarisa kana manhamba maviri ari kudzvanya zvisingaite achiswederana pamwe chete, kunonzi narrowed pulse pressure) uye kurova kwemoyo (kazhinji kacho kutsiva 0 paminiti imwe**20 sinus cardium).
6. Itai kuti murwere adzikame, achidziya, pakuzorora zvakakwana mumuviri, uye asingatombotauri nemuromo (hapana chokudya kana chekunwa). Kunyange kufamba uchienda kuchimbuzi kunogona kuwedzera kudiwa kweokisijeni kupfuura izvo mwoyo wakamanikidzwa unogona kupomba, zvichikonzera syncope kana Pulseless Electrical Activity (PEA) kusungwa kwemwoyo. Chengetedza murwere NPO mukugadzirira emergency ultrasound-inotungamirwa pericardiocentesis kana kuvhiya pericardial hwindo drainage.

Muti wechisarudzo: kuongorora pericardial effusion, post-pericardiotomy syndrome, uye tamponade¶

flowchart TD
    Start["Kupfupika Kwekufema, Kushushikana Kwechipfuva, kana Kureruka Nenhoroondo Yekuvhiyiwa Kwemoyo, Ablation, Pacemaker, Kenza, Kutadza Kweitsvo, kana Pericarditis."] --> RedFlags{"Tarisa Tamponade & Beck Triad Signs: Bulging neck veins (JVD), Systolic BP pasi pe100 mmHg, Narrowed Pulse Pressure, Tachycardia, Pulsus Paradoxus, kana Kupera simba?"}

    RedFlags -->|"HONGU kune CHIMWE chiratidzo: OBSTRUCTIVE TAMPONADE"| Emergency["CARDIAC TAMPONADE YAPO ZVINODA HUPENYU: Fonera Emergency Services (911 / 112 / 999) Chiripocho"]

    RedFlags -->|"HAPANA: Kurwadza kwechipfuva kwakapinza zviri nani kuzembera mberi, zvakajairika BP, hapana tsinga yemutsipa inoputika"| PPS["Inofungidzirwa Isinganzwisisike Pericarditis kana Post-Pericardiotomy Syndrome: Tsvaka nekukurumidza kuchipatara kuongororwa kwezuva rimwe chete uye echocardiogram yepadivi pemubhedha usati watanga colchicine kana NSAIDs."]

    Emergency --> Position["1. Position Semi-Upright or Sitting Leaning Forward on Pillow: Usambomanikidza flat supine kana dyspneic; gara uchizorora muviri"]

    Position --> NoMeds["2. ZVINHU ZVAKASIMBA ZVINOBHABISA: HAPANA Nitroglycerin kana Nitrates, HAPANA Diuretics (Furosemide / Mapiritsi emvura), uye HAPANA Aspirin kana Anticoagulant Doses."]

    NoMeds --> Hospital["3. Pre-Alert Hospital Cardiology Team: Immediate Bedside Ultrasound (POCUS), Reverse anticoagulants, uye Emergency Ultrasound-Guided Pericardiocentesis kana Surgical Window"]

Pathophysiology: iyo pericardial pressure-volume curve (fast vs. slow fluid buildup)¶

Mwoyo unogara mukati mechisaga chefibroserous chakapetwa kaviri chinonzi pericardium. Pakati pemukati wakatetepa we visceral layer (epicardium) yakanamirwa pamhasuru yemoyo uye yekunze yakaoma fibrous pericardium pane pericardial cavity, iyo inowanzo ine 15 kusvika 50 milliliters (1 kusvika 3 maspuni) emvura yakachena, yeruvara rwemashanga ye serous yemoyo wese inotutira.

Nekuti iyo yekunze fibrous pericardium inovakwa nedense, wavy collagen fibers yakasungirirwa ne elastic fibers, kugona kwayo kutambanudza kunoenderana zvachose ne **kuti inokurumidza sei ** fluid inopinda musaga. Hukama uhu hunotongwa neiyo classic Spodick J-yakaumbwa pericardial pressure-volume curve:

Chamber kuparara uye ventricular kupindirana¶

Sezvo kudzvinyirirwa kwemvura mukati meiyo pericardial sac inokwira kubva kune yayo yakajairika vacuum (-5 ku +5 mmHg) kusvika ku 15 kusvika 25 mmHg, inopwanya zvishoma nezvishoma makamuri emwoyo muhurongwa hwakasimba hwekukora kwemadziro uye kumanikidza kwemukati:

1. Atiriyamu yekurudyi uye mhepo yekurudyi inodonha kutanga: Nokuti atrium yekurudyi uye ventricle yekurudyi zvine madziro matete-madziro, low-pressure chambers (yakajairika diastolic pressure 3 kusvika 8 mmHg), inokwira pericardial fluid inovadzvanya nyoro panguva yekuzorora (**diastolic collapse **). Venous ropa rinodzoka kubva mumuviri kuburikidza nepamusoro uye yakaderera vena cava rinorova gonhi rakavharwa uye richidzokera kumusoro mumutsipa tsinga uye chiropa.
2. Kuenzana kwema diastolic pressures: Mutamponade inofefetera, kudzvanya kuri mukati me pericardial sac, right atrium, right ventricle, pulmonary artery diastolic, and left atrium (pulmonary capillary wedge pressure) zvese zvinoenzana pakusvika 18 kusvika 25 mmHg.
3. ** Ventricular interdependence: ** Nokuti ganda rekunze re pericardial rakavharwa pahuwandu hwehuwandu hwehuwandu, mhepo yekurudyi neyoruboshwe inofanira kukwikwidzana kune imwe nzvimbo yakasimba mukati mesaga, inoparadzaniswa chete nemuscular ** interventricular septum **. Pese apo murwere anofema mukati, chipfuva chisina kunaka chinosveta ropa rakawedzera retsinga mumhepo yakarurama; nokuti rusvingo rwekunze rwe pericardial harugoni kuwedzera kunze, mhepo yakarurama yekuzadza inoputira septum ye interventricular ** kuruboshwe mumhepo yekuruboshwe **, ichipwanya mhango ye ventricle yekuruboshwe uye inokonzera kudonha kamwe kamwe muropa rinoputirwa kunze kwemuviri (**pulsus paradoxus **).

Kuziva tamponade yekurapa kumba: Beck's triad, pulsus paradoxus, uye ECG zviratidzo.¶

Kusiyana nekuvhiyiwa kwekushungurudza tamponade uko hypotension uye kusungwa kwemoyo kunoitika mukati memaminitsi, ** zvekurapa (subacute) cardiac tamponade ** inowanzo mira kwemazuva sekuwedzera kuneta, kupfupika kwekufema pakuedza, kuzara kwechipfuva, chikosoro chakaoma, hiccups (kubva kune phrenic nerve irritation), hoarseness (kubva kudzokororo recurrent nerve bloating) (kubva pakukura kwechiropa).

1. Iwo 5 kadhiini padivi pemubhedha zviratidzo zvemoyo tamponade¶

2. Nzira yekutarisa sei yakamanikana pulse pressure uye pulsus paradoxus kumba¶

Nepo kuyerwa chaiko kwepulsus paradoxus kunoda bhuku reBP pressure cuff (sphygmomanometer) uye stethoscope muamburenzi kana muchipatara, imba yedhijitari yeBP uye zvigunwe zvako zvinogona kuratidza zviratidzo zvitatu zvakakosha zveyambiro paunenge wakamirira vanobatsira varwere:

1. Tarisa "Pulse Pressure" (Systolic minus Diastolic): Tarisa nhamba mbiri dzeBP dziri pascreen. Kazhinji, mukaha pakati penhamba yepamusoro (systolic) uye nhamba yepasi (diastolic) ndeye 40 kusvika 50 mmHg (somuenzaniso, 120/75 mmHg). Mukugadzira cardiac tamponade, intense adrenaline vasoconstriction inosundidzira nhamba yepasi ** kumusoro** ukuwo vhoriyamu yemoyo yakadzvanyirirwa yesitiroko ichisundidzira nhamba yepamusoro pasi, ichidzvanya pakakoromoka ku pasi pe25 kusvika 30 mmHg (somuenzaniso, 102/84 mmHg kana kuti **94/7 mmHg*8). Kutsikirira kwepamoyo kudiki kwakabatana nekurova kwemoyo kunopfuura 100 bpm chiratidzo chikuru chekuyeverwa kwekuvhunduka.
2. Inzwa kupururudza kwechanza panguva yekufema kwakanyarara: Isa zvigunwe zviviri zvinyoro nyoro paradial wrist pulse yemurwere uchiona chipfuva chavo chichikwira nekudonha panguva yekufema kwakajairika, kusingamanikidzwe (vaudze kwete kuti vafemere zvakanyanya kana kubata mweya wavo). Kana uchikwanisa kunzwa kurova kwepamoyo kuchiita kuderera zvinooneka kana kupera kwechinguva pese pavanenge vafema, uye vachidzokera kumashure zvinesimba pese pavanofema, yakaoma pulsus paradoxus (inowanzopfuura 20 kusvika 25 mmHg) iripo.
3. Varapi vanoyera sei pulsus paradoxus vachishandisa cuff yemaoko: A paramedic kana chiremba anosimudza 20 mmHg yeBP iri pamusoro pesimba uye anoibvisa zvishoma nezvishoma (2 mmHg pasekondi) uchiteerera ne stethoscope:
4. Point A: Rekodha kudzvinyirirwa uko kurova kwemoyo kweKorotkoff kwekutanga kunonzwika panguva yekufema chete (kunyarara panguva yekufema), semuenzaniso 118 mmHg.
5. Poindi B: Ramba uchifefetera zvishoma nezvishoma kusvikira kurohwa kwemwoyo kuchiramba kuchinzwika panguva yekufema nekufemesa, semuenzaniso 96 mmHg.
6. Chiverengero: Bvisa Poindi B kubva paPoindi A (118 - 96 = 22 mmHg) Chero musiyano unopfuura 10 mmHg is abnormal pulsus paradoxus.

3. Classic ECG siginecha: magetsi alternans¶

Apo vanobatsira varwere vanoisa 12-lead electrocardiogram (ECG) kumurwere ane pericardial effusion yakakura kana tamponade, vanotsvaga pathognomonic yekutsvaga inonzi **electrical alternans ** yakabatanidzwa ne **low QRS voltage **: - Nekuda kwekuti moyo wakaturikwa mukati mebhegi hombe remvura senge bhegi rekurovera rakarembera mumvura, moyo unotenderera uchienda mberi neshure mukati mesaga remvura nekurova kwega kwega (the "swinging heart" phenomenon on echocardiography). - Pamutsetse weECG, kuzununguka uku kunokonzera kureba uye axis yeQRS spikes kushandura ** kureba-kupfupi-kupfupi-kupfupi ** kubva kune imwe bhiti kuenda kune inotevera. Yakasanganiswa ne sinus tachycardia uye zviduku, muffled QRS complexes, magetsi alternans pakarepo anosimbisa kuputika kukuru kwepervical effusion.

Post-pericardiotomy syndrome (PPS / Dressler syndrome) uye post-procedural tamponade¶

Rimwe remapoka ane njodzi yepamusoro-soro yekukurumidza cardiac tamponade kumba ndeye murwere chero akavhiyiwa ** yakavhurika-moyo kuvhiyiwa, catheter ablation, pacemaker / ICD implantation, kana myocardial infarction mukati memazuva 1 apfuura kusvika masvondo masere **. Nzira mbiri dzakasiyana dzinogona kukonzera mvura kana ropa kuti rizadze pericardium mushure mekupindira kwemoyo:

1. Early or subacute hemopericardium (Mechanical kubuda ropa kana anticoagulation)¶

• Mukati memaawa 24 kusvika ku72 ekutanga (kana kusvika kumazuva gumi nemana pazvicherwa zveropa): Mushure mekunge coronary artery bypass grafting (CABG), heart valve replacement, atrial fibrillation catheter ablation, kana pacemaker lead placement, ropa rinogona kubuda kubva pamutsetse wekuvhiya, madziro eatrial ane perforated, kana atrial tip yekurudyi.
• Chest-tube clotting trap in post-op cardiac surgery: MuICU kana kutsika-pasi wadhi mushure mekuvhiyiwa kwemoyo wakavhurika, kana mediastinal chest chubhu kamwe kamwe kumira kudonhedza mvura panguva chaiyo iyo murwere anova tachycardic, hypotensive, uye kupfupika kwekufema, chubhu yechipfuva yakavharwa neropa, ichiteya mutsva weropa mukati memukati memoyo* tamponade**).
• Musungo wepanze anticoagulation: Varwere vakadzingwa kumba paapixaban, rivaroxaban, dabigatran, kana warfarin mushure mekuvhiyiwa kwevharuvhu kana kubviswa kweAFib kunogona kuita subacute bloody effusion 5 kusvika 21 mazuva gare gare. Chero dzungu nyowani, kudonha kweropa repamba, kana kupfupika kwekufema kunoda dhipatimendi rekukurumidzira echocardiogram.

2. Post-Pericardiotomy Syndrome (PPS) uye Dressler Syndrome (Autoimmune effusion)¶

Pakati pe ** 1 vhiki nemavhiki masere ** mushure mekuvhiyiwa kwemoyo wakazaruka (kunoitika mu10 kusvika ku30 muzana yevarwere vemwoyo), epicardial / catheter ablation, pacemaker implantation, kana chirwere chikuru chemoyo (apo inonzi **Dressler syndrome **), immune system yemuviri inowedzera kunonoka kuparara kweprotein yeropa uye masero eropa. pericardial nzvimbo.

• Yakajairika PPS yambiro zviratidzo:
• Pleuritic chest pain: Kupinza, kubaya retrosternal kana kuruboshwe-kuruboshwe kurwadza kwechipfuva kunowedzera kuipa paunofema kana kurara wakarara nemanhede, uye kunonatsiridza kana wakagara uye wakazendamira kumberi, kazhinji uchipenya kutrapezius ridge (pamusoro pepfudzi).
• Isingatsanangurike yakaderera-giredhi kana spiking fever (kazhinji 38.0 kusvika 39.0 madhigirii celsius / 100.4 kusvika 102.2 madhigirii Fahrenheit) inoonekwa kupfuura vhiki mushure mekuvhiyiwa pasina chero ronda kana hutachiona hwemapapu.
• Kufemereka kunoenderera mberi, kuneta, chikosoro chakaoma, uye kukweshana: Sezvo mvura inoputika ichidira mu pericardium (inowanzo perekedzwa nekuruboshwe ** pleural effusion ** kutenderedza mapapu), iyo yekutanga scratchy pericardial friction rub inogona kupera sezvo fluid layer inopatsanura the inflamed membranes, uye kukudziridza 2% yepicenta yemwoyo. nyaya **.
• Kurapwa muchipatara kwePPS (ESC Pericardial Disease Guidelines): Mutsara wekutanga unorwisa-kuzvimba kurapa ndeye Colchicine yakasanganiswa ne Aspirin kana kuti NSAID (yakadai seibuprofen) (kana yakaderera-dose corticosteroids kana ichirefractory/contraindicated), **mushure me echocardiogram inoyera kubuda kweropa.

Zvikuru zvekurapa zvinokonzeresa zvisiri-zvinoshungurudza pericardial effusion uye tamponade¶

Kunyange kana murwere asati ambovhiyiwa mwoyo kana catheter, zvirwere zvakasiyana-siyana zvinowanzovapo kune dhipatimendi rekukurumidzira kekutanga sehupenyu hunotyisa hwemoyo tamponade:

Nei iyo "PRELOAD, RATE, AFTERLOAD" mitemo yefiziology inotonga rubatsiro rwekukurumidzira¶

Chese chiito chinotorwa nevanomira pamba uye vanobatsira varwere vari mumunda chinotaridzwa nekuti moyo wakamanikidzwa unogara sei uri mupenyu. Mumoyo tamponade, mwoyo wakavharirwa muvise: its ** stroke volume inogadziriswa uye idiki **. Kudzivirira kamwe kamwe Pulseless Electrical Activity (PEA) kusungwa kwemoyo, mbiru nhatu dzemuviri dzinofanirwa kuchengetedzwa chero zvipi:

CARDIAC OUTPUT = (HIGH VENOUS PRELOAD) x (FAST HEART RATE) x (INTACT ARTERIAL VASCULAR TONE)

1. Chengetedza Venous Preload (Nei Nitroglycerin uye Diuretics Zvichiuraya): Chikonzero chega chero ropa riri kupinda muatrium yekurudyi yakapwanyika (apo kunze kwepervical pressure iri 20 mmHg) ndeyekuti muviri wakadzvanya tsinga dzawo kuti ukwidze pakati venous pressure kusvika 22 mmHg. Kana mumwe munhu akapa murwere sublingual nitroglycerin, isosorbide, furosemide (Lasix), kana morphine, venous pressure inodonha kubva pa22 mmHg kusvika pa12 mmHg. Pakarepo, iyo 20 mmHg pericardial fluid inorovera iyo atrium yekurudyi yakavharika zvachose, kubuda kwemoyo kunodonha kusvika zero, uye murwere anosungwa.
2. Chengetedza Compensatory Tachycardia (Nei maBeta-Blockers Aine Ngozi): Nekuti moyo wakadzvanywa unogona kungopomba mamililita 20 kusvika ku25 pabhiti panzvimbo ye70 milliliters yakajairika, kurova kwemoyo kunosvika 110 kusvika 130 kurova paminiti ndicho chinhu chega chinochengeta ropa richiyerera richienda kuuropi. Usambofa wakapa beta-blockers (metoprolol, propranolol, atenolol) kana kuti non-dihydropyridine calcium channel blockers (diltiazem, verapamil) kuti inonoke kurova kwemwoyo kunofungidzirwa kuti tamponade.
3. Nei Positive-Pressure Intubation Inogona Kukonzera Kusungwa Kwemoyo Pakarepo: Muchipatara, vanachiremba vekukurumidzira vanodzivirira kupinza uye kuisa murwere wetamponade pane mechanical ventilator ASATI abvisa pericardium pese pazvinogoneka. Zvese zviri zviviri sedative induction zvinodhaka (izvo dilate tsinga uye kudonhedza preload) uye positive-pressure mechanical breaths (iyo inofuridzira mweya wakanaka muchipfuva uye inowedzera kusvina vena cava uye right atrium) zvinowanzokonzera pakarepo kusungwa kwemwoyo pamubhedha. Pane kudaro, vanachiremba vanogadzirira chipfuva neantiseptic apo murwere achiri akamuka, ita ** kusvinura local-anesthetic ultrasound-guided pericardiocentesis ** kubvisa yekutanga 50 kusvika 100 milliliters emvura (iyo inodzorera pakarepo BP), uye intubate pashure kana zvichidiwa.

Definitive hospital treatment: Ultrasound-inotungamirirwa pericardiocentesis uye hwindo rekuvhiya¶

Pane imwe nguva mudhipatimendi rekukurumidzira, ** pemubhedha point-of-care ultrasound (POCUS) / echocardiogram ** inotora zvishoma kudarika 60 seconds kuti ione rima remvura halo rakakomberedza mwoyo, simbisa diastolic kuputsika kweatrium yakarurama uye ventricle yakarurama, uye kuratidza plethoric (yakaparara, isina kudonha) inferior vena.>2.1 cm dhayamita ne <50% kudonha kufemerwa).

• Emergency Pericardiocentesis: Pasi penguva chaiyo yeultrasound kana fluoroscopic nhungamiro (uchishandisa tsono yeparasternal, apical, kana subxiphoid iri pazasi pepfupa rezamu yakakona kuenda pabendekete rekuruboshwe), chiremba wemwoyo kana chiremba wechimbichimbi anopinza tsono munzvimbo yepericardial, anopinza munyoro pigtail drainage catheter uye inotungamira catheter. Nekuda kwekudzika kwakaita J-shaped pressure-volume curve, kungobvisa 50 kusvika ku100 milliliters emvura pakarepo kunodonhedza intrapericardial pressure kusvika pedyo ne zero, zvichiunza kusununguka kukuru, nekukasika kwekupfupika kwekufema uye kudzoreredzwa kweropa rakajairwa patafura.
• Chenjerera Pericardial Decompression Syndrome (PDS): Muvarwere vane hombe, kusingaperi effusions (1,000+ mL), varapi vanodzivirira kudonhedza anopfuura 500 kusvika 1,000 milliliters kamwechete, kudonhedza yasara zvishoma nezvishoma kwemaawa makumi maviri nemana kuburikidza necatheter kuitira kuti kamwe kamwe kusadzora kurege kufashama-distening yekurudyi.
• Kuvhiya Subxiphoid Pericardial Window kana Thoracotomy: Inoshandiswa pakuvhara mushure mekuvhiyiwa hemopericardium (isingakwanise kupfuura nepakati petsono nhete), purulent bacterial pericarditis, kana kuputika kunowanzoitika.

Nhamba dzenharaunda dzechimbichimbi uye zvirongwa zveagency¶

Kufungidzira cardiac tamponade kana post-cardiac-procedure deterioration inoda kukurumidza kutakura amburenzi kuenda kuchipatara ne 24-hour emergency echocardiography, cardiology, uye cardiothoracic operation:

• United States neCanada: Dial 911. Kana murwere achangobva kuvhiyiwa mwoyo, kubvisa, kana pacemaker yakasimwa, vauye nepfupiso yavo yekuvhiya yekuvhiya uye kadhi rekuzivikanwa kwemudziyo, uye ita kuti mhuri ifonere pa-call cardiology shamwari apo EMS iri munzira.
• United Kingdom: Dhonza 999 ye emergency Chikamu ½ amburenzi kuchipatara chikuru chakakomba Dhipatimendi reEmergency (A&E) kana Heart Attack/Cardiac Center. Inotungamirirwa pasi pe **ESC uye Resuscitation Council UK ** zvinogadziriswa zvinokonzeresa zvekusungwa kwemoyo ("4 Hs uye 4 Ts": Tamponade, cardiac).
• European Union: Dial 112. Inotungamirirwa pasi pe **European Society of Cardiology (ESC) Mirayiridzo yeKuongorora uye Kutungamirirwa kwePericardial Diseases **.
• Australia neNew Zealand: Dial 000 muAustralia kana 111 muNew Zealand.
• India neAsia-Pacific: Dial 112 (kana 108 muIndia), 995 muSingapore, 119 muJapan neSouth Korea, kana 999 muMalaysia neHong Kong. Kumbira kutakurwa kuenda kuchipatara chepamusoro chine 24-hour cardiac catheterization lab uye ICU.

Mibvunzo inowanzo bvunzwa¶

Ndeupi musiyano uripo pakati pe pericardial effusion uye cardiac tamponade?¶

A pericardial effusion zvinongoreva kuti kune imwe mvura yakawedzerwa pamusoro penguva dzose 15 kusvika ku50 milliliters mukati mesaga rakapoteredza mwoyo; kana ikavaka zvishoma nezvishoma kana kuti ikaramba iri duku, inogona kukonzera kusamanikidzwa pamakamuri emwoyo zvachose. Cardiac tamponade ndiyo yekukurumidzira inotyisidzira hupenyu inoitika kana kudzvinyirirwa kwemvura iyoyo kunopfuura kumanikidza kwekuzadza mukati meatrium chaiyo uye ventricle yekurudyi, nekupwanya makamuri emoyo panguva yekuzorora kuitira kuti moyo urege kuzadza neropa kana kupomba oxygen yakakwana kumuviri.

Sei diki 150 mL ichigona kubuda ropa mushure mekubvisa ablation kukonzera tamponade, nepo murwere wegomarara achigona kubata 1,500 mL yemvura?¶

Iyo yekunze fibrous pericardial sac yakagadzirwa nedense collagen fibers inoramba kutambanudza kamwe kamwe. Kana ropa rikanyudza nekukasira muchisaga mumashure maminetsi mushure mecatheter ablation kana pacemaker process, pericardium haigone kutambanudza, saka 100 kusvika 200 milliliters yeropa inomhanyisa kukwira kumusoro uye kumisa moyo. Kana mvura ikaunganidza kudonha nekudonha kwemavhiki kubva mukenza yemapapu kana yemazamu, kutadza kwetsvo, kana hypothyroidism, iyo pericardial fibers inotambanudza zvishoma nezvishoma uye inogadzirisa, ichibvumira sac kubata 1 kusvika 2 malita isati yasvika pakuputsika kwayo.

Sei kusendamira mberi kuchiita kuti kufema uye kurwadziwa kwechipfuva kunzwe zviri nani mu pericarditis uye pericardial effusion?¶

Kana murwere akazvambarara nemusana, simba rinokwevera zvinhu pasi rinokwevera mwoyo kumashure kumusana uye rinogovera pericardial fluid kumativi emashure emakamuri uye bronchi, uku ichikwiza mutsara we pericardial pa diaphragm uye pleura. Kugara wakatwasuka uye wakazendamira mberi papiro kana tafura (nzvimbo yetripod) inomisa moyo mberi mukati mechipfuva uye inodziva kubuda kwakananga kumberi kwehomwe yakaderera yesaga, kubvisa kudzvanywa kwebronchi uye kuderedza marwadzo epleuritic.

Chii chinonzi Beck's triad, uye nei usingafaniri kumirira zviratidzo zvose zvitatu mune tamponade yezvokurapa?¶

Beck's triad ine zviratidzo zvitatu zvepakutanga zvakatsanangurwa mu acute surgical tamponade: low arterial blood pressure (hypotension), bulging neck veins (jugular venous distension), uye kure, muffled heart sounds. Mune tamponade yezvokurapa inokura nemazuva, zviratidzo zvese zvitatu zvinoonekwa pamwe chete mune isingasviki makumi matatu kusvika ku40 muzana yevarwere, uye BP inowanzogara yakajairika kana kunyange yakakwirira kusvika maminetsi asati asungwa mwoyo. Gara uchiita maererano nezviratidzo zvekutanga: kuwedzera kupfupika kwekufema nemapapu akajeka, kurova kwemoyo kuzorora kupfuura 100 bpm, mukaha mudiki pakati pesystolic nediastolic blood pressure, uye pulsus paradoxus.

Chii chinonzi Post-Pericardiotomy Syndrome (PPS) mushure mekuvhiyiwa kwemoyo?¶

Post-Pericardiotomy Syndrome (inoenderana neDressler syndrome mushure mekurwadziwa kwemoyo) ndeye autoimmune inflammatory reaction ye pericardium uye pleura inokura 1 kusvika kumavhiki masere mushure mekuvhiyiwa kwemoyo wakazaruka, kuchinjwa kwevhavha, catheter ablation, kana pacemaker kuiswa. Zvinokonzera kurwadza kwechipfuva kunowedzera kana uchifemera mukati kana kuti wakarara pasi, fivha isingatsananguriki, kuneta, uye kuungana kwemvura kutenderedza moyo nemapapu. Nepo zviitiko zvakawanda zvichipindura colchicine uye anti-inflammatory therapy, murwere wese ane zviratidzo zvePPS anoda kukurumidza echocardiogram kuti ave nechokwadi chekuti mvura haisi kufambira mberi kune cardiac tamponade.

Sei zvine ngozi kupa nitroglycerin kana piritsi remvura (furosemide) kumunhu ane tamponade yemwoyo?¶

Mu cardiac tamponade, kudzvanya kwemvura yekunze kuri kudzvanya rutivi rworudyi rwemwoyo kuvharika, uye simba chete rinosunda ropa mumwoyo kukwira kwetsinga yemurwere. Nitroglycerin inoderedza tsinga uye furosemide inodhonza mvura kubva muropa; chero mushonga unokonzera venous kuzadza kumanikidzwa kudonha pasi pepervical fluid pressure, zvichiita kuti ventricle yerudyi idonhe zvachose uye zvichikonzera kudonha kwemoyo nekukurumidza uye kusungwa kwemoyo.

Nzvimbo uye nhungamiro yepamutemo¶

• European Society of Cardiology (ESC, Europe): ESC Mirayiridzo yeKuongororwa uye Kutungamira kwePericardial Diseases (Adler et al., European Heart Journal, triage yemoyo tamponade, post-pericardiotomy syndrome, uye pericardiocentesis protocol) uye ESC Working Boka paMyocardial Cardiac uye Pericardial Management Tamponade.
• American Heart Association (AHA) neAmerican College of Cardiology (ACC, United States): 2020 AHA/ACC Guidelines for Advanced Cardiovascular Life Support (ACLS) uye ASE/AHA Clinical Recommendations for Multimodality Cardiovascular Imaging yeVarwere vane Pericardial Disease.
• Resuscitation Council UK & National Institute for Health and Care Excellence (NICE, United Kingdom): Advanced Life Support (ALS) Mirayiridzo: Zvinogadziriswa Zvinokonzera Kusungwa Kwemoyo (4 Hs uye 4 Ts - Cardiac Tamponade).
• Spodick DH (New England Journal of Medicine): Acute Cardiac Tamponade (Pericardial pressure-volume curves, ventricular interdependence, uye pulsus paradoxus physiology).
• International Federation of Red Cross uye Red Crescent Societies (IFRC) & ANZCOR: Nhungamiro Yerubatsiro Rwekutanga kune Acute Chest Pain, Dyspnea, uye Circulatory Shock.

Mazano anoenderana¶

• Cardiac tamponade uye inopinda muchipfuva trauma triage
• Pericarditis, myocarditis, uye post-viral chipfuva kurwadziwa tsvuku mireza
• Pacemaker kana ICD defibrillator inovhundutsa dutu uye hutachiona hwehomwe yemidziyo
• Aortic dissection uye kuputika abdominal aortic aneurysm
• Kuzivikanwa kwekuvhunduka uye rubatsiro rwekutanga rwechimbichimbi