In daily life, many people have encountered chest tightness or shortness of breath discomfort, and most people's first thought may be heart or lung disease. Indeed, the most common causes of chest tightness and shortness of breath are coronary heart disease, heart failure or chronic lung disease. However, there is a clinical disease that can also cause obvious chest tightness, shortness of breath symptoms, and is easily misdiagnosed as heart failure or other diseases, that is pericardial effusion.
- The pericardial effusion exceeding 50 ml should be vigilant
The importance of the heart to the human body is self-evident, and the pericardium is probably much less well-known or known to the public than the heart.
The pericardium is like the outer coat of the heart, an organ that wraps around the surface of the heart and holds it in place in the chest and protects and cushions the beating of the heart. The pericardium itself is divided into two layers, the inner layer is directly wrapped around the surface of the heart, anatomically called the visceral pericardium, and the outer layer is thicker, anatomically called the parietal pericardium, and the two layers form a double layer "jacket" that protects our heart.
The closed space between the two layers of pericardium is called the pericardial cavity, and under normal circumstances, the pericardium itself contains a small amount of liquid, a total of about 10 ml to 15 ml, which can play a lubricating role and make the heart beat more effortlessly and effectively. However, if the pericardium itself appears inflammatory reaction or combined with systemic disease, resulting in a significant increase in the pericardial effusion, the total amount of more than 50 ml, it is called pericardial effusion.
Specifically, the volume or volume of pericardial effusion can be determined by a cardiac ultrasound. The severity of pericardial effusion was assessed according to the echocardiographic image, which was divided into mild pericardial effusion (effusion volume 50 ml to 100 ml). The echocardiographic image only showed the effusion behind the heart near the right atrium, and the echoless depth was 500 ml. The maximum width of the echoless area around the heart was >20 mm.
- Most of the causes were viral infection
The mechanisms of pericardial effusion are varied. Any disease that increases the production of pericardial fluid or reduces the return of pericardial fluid can cause symptoms of pericardial effusion. The specific causes can be simply divided into infectious and non-infectious two categories.
The so-called infectious pericardial effusion refers to the inflammation in the pericardial cavity due to the involvement of various pathogens after infection, and then the disease. Infectious pericardial effusion is more common viral infection or tuberculosis infection.
Simple pericardial effusion caused by viral infection can often improve on its own within one to two weeks, most of which do not require special treatment and can be given appropriate clinical monitoring and observation. However, some viral infections can involve the heart muscle at the same time, causing myocarditis and pericardial effusion, and some acute inflammatory reactions lead to severe chest pain, and even cause myocardial infarction or aortic dissection. This situation requires doctors to make timely and accurate judgments, rule out potentially life-threatening diseases, and give corresponding active treatment. In severe cases, there may be an acute increase of pericardial fluid for a short time, which significantly increases the pressure of the pericardial cavity, and then presses the heart, and even leads to cardiac tamponade (pericardial effusion increases the pressure of the pericardial cavity, which can affect the cardiac ejection function and threaten life in severe cases, which is called pericardial tamponade). For this situation, we should consider active symptomatic treatment and pericardial puncture, drainage of fluid, reduce pericardial pressure, relieve cardiac pressure, and ensure the stability of patients' vital signs.
The pericardial effusion caused by tuberculosis infection will have some unique manifestations of tuberculosis infection, such as low afternoon fever, wasting, night sweats, and some may be combined with pulmonary tuberculosis infection, and there are characteristic tuberculosis imaging manifestations of the lungs. Clinically, if tuberculous pericardial effusion is diagnosed, regular anti-tuberculous therapy should be given. However, some tuberculous pericardial effusion is difficult to confirm the diagnosis, and it is often a suspected or highly suspected diagnosis after excluding other common causes.
As for non-infectious pericardial effusion, its cause is more complex, often systemic disease pericardial involvement. More common are rheumatic fever, autoimmune diseases, and endocrine disorders (such as hypothyroidism or hyperthyroidism). Some patients with malignant tumors can also be combined with pericardial effusion, often accompanied by wasting, night sweats and bad fluid and other wasting manifestations of malignant tumors. Patients with such pericardial effusion should be actively treated for the systemic primary disease.
- Eliminating "pericardial tamponade" is more important
In clinical work, doctors will identify two key issues for patients with pericardial effusion: first, the amount of pericardial effusion, the speed of effusion progression and its impact on cardiac function; Second, identify the underlying cause as soon as possible and treat the cause as early as possible if necessary.
It should be emphasized here that simply paying attention to the amount of pericardial effusion is not enough, and attention must be paid to the speed of pericardial effusion accumulation and the impact on the normal ejection function of the heart. If the pericardial effusion accumulates rapidly and the course of the disease is obvious, a small amount of effusion can also lead to an increase in pericardial pressure within a few minutes, leading to obvious cardiac tamponade symptoms and endangering the life of the patient, which is called acute pericardial tamponade.
When the effusion appears slowly, the pericardium has a larger capacity to extend and can accommodate more effusion. However, if the cause cannot be relieved, the continuous increase of pericardial fluid will eventually lead to a significant increase in pressure in the pericardial cavity. Subacute pericardial tamponade may occur when the pressure in the pericardial cavity increases enough to prevent the heart from filling, and can progress over a period of days to weeks.
In summary, for patients with definite pericardial effusion, it is necessary to first determine whether there are life-threatening conditions such as pericardial effusion combined with pericardial tamponade, and whether there are systemic diseases combined. If the disease associated with pericardial effusion is found, the primary disease should be actively treated. Because some pericardial effusion can become chronic or recurrent, such as tuberculous pericardial effusion and tumor-associated pericardial effusion, clinical emphasis is on regular review according to individual patient conditions.
How to treat pericardial effusion?
For patients with unstable vital signs, the main treatment is immediate pericardiocentesis to remove pericardial effusion, especially under cardiac ultrasound or fluoroscopy. Some patients who are contraindicated or unable to perform pericardiocentesis (aortic dissection leading to pericardial tamponade) may consider surgery. If recurrent or chronic pericardial effusion occurs repeatedly, or it is difficult to determine the nature and cause of pericardial effusion, pericardial puncture or surgical biopsy should also be considered to determine the nature and cause of pericardial effusion.
Patients should be monitored for at least 24 to 48 hours after percutaneous or surgical drainage of pericardial effusion in patients with pericardial tamponade. Echocardiography can be performed again before the patient is discharged to determine the specific condition of pericardial effusion and confirm whether there is recurrence.
In general, early follow-up echocardiography should be performed within one to two weeks after discharge, and again at six months after discharge, after which the frequency of follow-up should be individually adjusted according to the cause, symptoms, or recurrence of the original effusion.
