心脏直视手术后缩窄性心包炎

随着心脏外科的迅速发展,心脏直视手术逐渐成为缩窄性心包炎的重要病因之一。多种致病因素共同介导了这一病理生理过程,临床上表现为一系列难以解释的顽固性右心衰的症状及体征。除影像学检查外,对疑似患者必须行右心导管检查以明确诊断。由于该病起病隐匿、辅助检查结果并不典型,及时准确诊断不容易,临床上常常出现漏诊及误诊。手术后心包积液是该病重要致病因素之一,中量以上者应积极行闭式引流;已确诊者除药物治疗外原则上应尽早行心包切除术以避免心肌萎缩,手术效果取决于病程长短。     

尿毒症心包炎的临床研究

本文40例维持性血透尿毒症患者中,心包炎的发生率约为35％.除心包摩擦音外,来见其它特殊临床症状.约50％的患者无任何症状.诊断依靠超声心动图检查.查明患者有无心包积液、心包填塞、心包积液量以及心包炎及范围具有一定价值。该病需加强透析治疗,包括延长透析时间、缩短透析间隔,使用高效、高通透膜,加用血滤及血液灌流,减少肝素用量或改为腹透。本文也讨论了该病的病因.     

皮肌炎引起血性心包积液一例报告

皮肌炎可累及心脏引起心包积液,该病所致心包积液性质罕见文献描述。兹将皮肌炎引起血性心包积液一例报道如下。患者男性,53岁,1987年5月27日入院。该患者于入院前三个月开始尿少、下肢水肿,乏力并伴大     

甲状腺功能减退性心脏病的超声诊断初探

分析13例甲状腺功能减退性心脏病的超声表现,提示该病的重要超声特征有:①少量心包积液,②左室后壁搏动幅度普遍性下降。③主动脉硬化。如结合实验室检查和临床表现,有利于甲状腺功能减退性心脏病的尽早诊治。     

闭式引流并心包内注射尿激酶对结核性包裹性心包积液的临床疗效评价

正临床普遍认为结核性心包炎是导致心包积液的原因之一,也是肺外结核的一种常见疾病。该病病死率较高,有研究发现,结核性心包炎在我国的病死率高达40%。本研究应用闭式引流并心包内注射尿激酶治疗结核性包裹性心包积液,以探究其确切的临床疗效,现进行如下报道。1资料与方法1.1一般资料选取本院2013年1月至2017年1月收治的92例结核性包裹性心包积液进行研究,按照随     

发炎的心脏:老年人心包炎

许多疾病过程可累及心包(见附表),在老年病人更是如此。从临床和病理生理学观点看,心包病变有三种类型:急性心包炎,心包积液,和缩窄性心包炎。广义地说来,可将其通称为“心包炎”。心包的炎症通常累及脏层和壁层;几乎没有任何疾病是单单影响心包的。心包炎可以是全身性疾病如尿毒症、红斑性狼疮,结核,或肿瘤的最初表现。     

转移性心包癌的心电图分析——附5例报告

我院经尸检及细胞学证实肺癌并心包转移癌5例(见附表)。讨论转移性心包癌一般发生于癌症晚期,其原发癌以肺癌多见。本文5例均系肺癌晚期转移心包。转移性心包癌心电图常表现与心包炎相似的特征,即ST-T改变及QRS低电压,常伴有心动过速、房颤、房扑或早搏等。本文4例表现为心包炎征象。癌症晚     

以血性心包积液为首发表现的系统性红斑狼疮1例

目的　应用免疫学检查早期发现系统性红斑狼疮 (SLE)。方法　心包积液穿刺抽液常规免疫学检查。结果　SLE所致的血性心包积液 ,免疫学检查有特异表现。结论　应用免疫学检查有助于及早发现以心包积液为首发表现的SLE ,以免引起漏诊和误诊。     

慢性非特异性渗出性心包炎(附2例报告)

报告2例较少见的慢性非特异性渗出性心包炎。2例均有心包积液和填塞的各种表现,病程均在半年以上。1例完全不伴有发热,另1例偶有低热或中度发热。主要病理改变是心包非特异性炎症。治疗上主要采取心包-胸膜开窗或心包切除。     

老年结核性缩窄性心包炎心包剥脱术后并发呼吸衰竭一例的护理

<正>缩窄性心包炎是指心包发生炎症后,僵硬、坚厚、纤维化的心包包裹心脏,使正常的回心血量减少,心室的充盈受到影响,出现心排量减少,静脉压升高的一系列循环障碍的临床表现~([1])。在我国,结核病是缩窄性心包炎的主要病因,也是老年缩窄性心包炎的主要病因~([2])。该病一旦确诊应尽早进行手术治疗,以解除心脏的束缚,心包剥脱术是最有效的治疗手段~([3])。有文献报道,心包剥脱手术死亡率为6%～12%~([4]);另有研究发现,影响患者行心包剥脱术的危险因素有年龄因素,年龄越大,手术风险越高~([5-6]),术后死于呼吸衰竭的比例很高~([7])。因此,老年患者术后的护理成为护理工作的难点。2019年5月,我院结核重症监护室收治了1例结     

大量心包积液和心脏压塞的诊断和治疗

目的探讨大量心包积液和心脏压塞的诊断和治疗经验。方法回顾性分析1998年1月至2003年1月我科收治的36例心包积液致心脏压塞患者的临床资料，其中男性25例，女性11例，均由彩色超声心动图证实有心包积液及心脏压塞，15例采用剑突下心包开窗、放置引流管，21例采用经皮穿刺置管引流的方法。如病因不明，引流液尚需作进一步检查。结果经引流15min～2h后患者心脏压塞症状立即改善，早期34例生存，2例死亡病例分别因低心排出量和急性肝、肾功能衰竭于引流术后第2、7d死亡。结论早期准确诊断、彩色超声心动图指导下及时引流解除心脏压塞，可减轻症状并为进一步治疗提供保障。     

Unexplained recurrent pericardial effusion: a lethal warning?

A case of a 37 year old man with cardiac angiosarcoma causing recurrent pericardial effusion, who eventually died of cardiac rupture, is presented. The diagnosis was not established until the postmortem examination despite echocardiography, pericardiocentesis, and pericardial biopsy investigations. There is neither a specific manifestation that enables early recognition nor well proven effective treatment against this disease. Accordingly, the prognosis of cardiac angiosarcoma remains grave. A high index of suspicion is recommended in patients who present with unexplained pericardial effusion.     

Tamponnade tardive : quatre cas de complication rare du traumatisme fermé du thorax

Delayed post-traumatic pericardial effusion is a rare condition after blunt trauma. The diagnosis of the effusion can be made by the clinical signs, which is not very specific and the cardiac echography. The etiological diagnosis remains difficult because it requires the elimination of the other causes of pericarditis. Their treatment consists in evacuating the pericardial effusion. The evolution thereafter is simple. We report four cases of patients with pericardial effusion late after a thoracic injury. Imaging the blood test, the examination of the pericardial fluid and the anatomopathological examination of the pericardium, eliminates the other etiologies.     

Adenocarcinoma of the lung presenting with pericardial tamponade: report of a case and review of the literature

In a patient with cancer, a diagnosis of cardiac tamponade should be considered when there is dyspnea, cough, thready pulse or pulsus paradoxus, low systolic blood pressure, engorged neck veins, an enlarged cardiac silhouette, and total or ventricular electrical alternans. Immediate pericardiocentesis is indicated in such patients to avoid the risk of sudden death. A pericardial window should be created for more prolonged palliation of cardiac tamponade. Cytologic examination of the pericardial fluid often reveals malignant or highly suspect cells. Metastatic carcinomas from the lung and breast are the most common tumors that involve the heart when they spread in a retrograde fashion through the cardiac lymphatic system. Total pericardiectomy for the treatment of cardiac tamponade that is due to cancer is not generally advisable. Radiation therapy in the cardiac area with or without systemic chemotherapy is effective in decreasing the amount and the recurrence of neoplastic pericardial effusion.     

Pericardial effusion and tamponade

Pericardial effusion may occur as a result of a variety of clinical conditions, including viral, bacterial, or fungal infections and inflammatory, postinflammatory, autoreactive, and neoplastic processes. More common causes of pericardial effusion and tamponade include malignancy, renal failure, viral and bacterial infectious processes, radiation, aortic dissection, and hypothyroidism. It can also occur after trauma or acute myocardial infarction (as in postpericardiotomy syndrome following cardiac or thoracic surgery) or as an idiopathic pericardial effusion. Although pericardial effusion is common in patients with connective tissue disease, cardiac tamponade is rare. Among medical patients, malignant disease is the most common cause of pericardial effusion with tamponade. Table 1 shows the causes of pericardial tamponade. The effusion fluid may be serous, suppurative, hemorrhagic, or serosanguineous. The pericardial fluid can be a transudate (typically occurring in patients with congestive heart failure) or an exudate. The latter type, which contains a high concentration of proteins and fibrin, can occur with any type of pericarditis, severe infections, or malignancy. Once the diagnosis of pericardial effusion has been made, it is important to determine whether the effusion is creating significant hemodynamic compromise. Asymptomatic patients without hemodynamic compromise, even with large pericardial effusions, do not need to be treated with pericardiocentesis unless there is a need for fluid analysis for diagnostic purposes (eg, in acute bacterial pericarditis, tuberculosis, and neoplasias). The diagnosis of pericardial effusion/tamponade relies on a strong clinical suspicion and is confirmed by echocardiography or other pericardial imaging modalities. Alternatively, when the diagnosis of cardiac tamponade is made, there is a need for emergency drainage of pericardial fluid by pericardiocentesis or surgery to relieve the hemodynamic compromise. Following pericardiocentesis, it is necessary to prevent recurrence of tamponade. Intrapericardial injection of sclerosing agents, surgical pericardiotomy, and percutaneous balloon pericardial window creation are techniques used to prevent reaccumulation of pericardial fluid and recurrence of cardiac tamponade.     

Evaluation of children with a large pericardial effusion and cardiac tamponade

OBJECTIVES: Large pericardial effusions and cardiac tamponade are rare in childhood.The aim of this study was to evaluate the aetiological factors and clinical findings of large pericardial effusion and cardiac tamponade in children. METHODS: We reviewed retrospectively the records of 10 (6 male, 4 female) patients (mean age: 8.05 +/- 4.4 y) with the diagnosis of large pericardial effusion and cardiac tamponade requiring pericardiocentesis and pericardial drainage between 2002 and 2004. RESULTS: After extensive diagnostic investigation we detected that three patients had tuberculosis, one patient had uraemic pericarditis; one patient had bacterial pericarditis; one patient had post-pericardiotomy syndrome; two patients had malignancy and two patients had no identifiable aetiology. Echocardiography-guided percutaneous pericardial puncture and pigtail catheter placement is safe and effective for initial treatment of patients with large pericardial effusion and cardiac tamponade and in most cases, initial assessment with clinical, serologic, and radiologic investigation and careful follow-up can reveal the aetiology. CONCLUSIONS: Although tuberculosis is rare in industrialized countries, in developing countries it remains one of the most important causes of large pericardial effusion and should be investigated and excluded in each patient.     

Tamponnade et myocardite aiguë au cours d’un syndrome de Churg-Strauss

Introduction

The successive occurrence of pericardial tamponade and myocarditis during a Churg-Strauss syndrome is exceptionally described. We report a patient in whom pericardial tamponade and myocarditis were the presenting manifestation of a Churg-Strauss syndrome.

Case report

A 58-year-old woman was admitted because of alteration of the clinical status with eosinophilia. One month ago, she was hospitalized for a pericardial tamponade treated by pericardial drainage. Acute myocarditis was diagnosed on chest pain during the second hospitalization. The etiologic inquiry ended in the diagnosis of Churg-Strauss complicated with a double cardiac involvement. A good response of clinical and biological anomalies was obtained after corticosteroid and immunosuppressive treatment.

Conclusion

Isolated or multiple involvements of cardiac tunics should lead to make diagnosis of systemic vasculitis. A complete initial assessment and a close observation of the patients followed for Churg-Strauss syndrome is imperative to detect a cardiac achievement and set up an early treatment.     

Neoplastic pericardial disease

The spread of metastatic cancer to the pericardium is the most common cause of cardiac tamponade in medical inpatient settings. Lung cancer, breast cancer, and the hematologic malignancies account for some three quarters of the cases. Occasionally, usually in lung cancer, the pericardial involvement is the first clinical presentation of the neoplastic disease. Differential diagnosis includes radiation pericarditis and cardiac toxicity from chemotherapeutic drugs, as well as any of the causes of pericardial disease in patients without neoplasm. Idiopathic nonneoplastic, noninflammatory pericardial effusion is surprisingly common in cancer patients. The initial cardiac tamponade may be managed with either needle tap or subxiphoid pericardiostomy. Pericardiocentesis, performed with echocardiographic guidance and followed by percutaneous catheter drainage for several days, is safe and effective in neoplastic pericardial effusion. It may be the only local therapy that is needed. Further local treatment, for those patients who develop recurrent cardiac tamponade after an initial drainage procedure, may include tetracycline sclerosis of the pericardial space, instillation of cancer chemotherapeutic agents, radiation therapy, and pericardiectomy. No controlled clinical trials of these methods of treatment are available. The choice of therapy is based on various considerations in individual patients, particularly the patient's general condition and the likelihood of a long-term response to treatment of the systemic neoplastic disease.     

Primary cardiac lymphoma: diagnosis by transjugular biopsy

Primary cardiac lymphoma, defined as a non-Hodgkin's lymphoma involving only the heart and pericardium, is an extremely rare malignancy. It should be suspected in patients with a heart mass and heart failure, unexplained refractory pericardial effusion or rhythm disturbances. Transvenous intracardiac tumor biopsy under fluoroscopic or transesophageal echocardiographic guidance, is a minimally invasive technique which makes definite diagnosis possible. We describe a patient in whom primary cardiac lymphoma was diagnosed by this technique. He also underwent percutaneous balloon pericardiotomy because of severe refractory pericardial effusion. Seven months after diagnosis and treatment with standard chemotherapy, the patient remained free of disease.     

Cardiac actinomycosis in a patient presenting with acute cardiac tamponade and a mass mimicking pericardial tumour

A case of pericardial actinomycosis mimicking a pericardial tumour is reported. After the appearance of non-specific subpleural pulmonary nodules, a 48 year old woman presented with fever and clinical signs of pericardial tamponade. Subxiphoid pericardiotomy yielded a culture negative fluid and inflammatory reactive histopathology in the pericardial biopsy specimen. Because of suspected infection cefamandole was administered for 10 days and the patient became afebrile. The pericardial effusion recurred with no clinical signs two weeks later. Steroid medication resulted in rapid regression of the pericardial effusion. Subsequent echocardiography controls showed a tumour-like pericardial mass, confirmed by cardiac magnetic imaging. Surgical exploration led to the final histological diagnosis of actinomycosis. After high dose and long term penicillin G treatment the patient recovered fully with no recurrence during two years' follow up.