Symptoms of hydropericardium, methods of diagnosis and treatment

Causes of hydropericardium, its signs and treatment with modern methods

The pericardium is a two-layered pouch that houses the heart. Hydropericardium is the appearance of excess fluid between these layers. Normally, the amount of fluid is from 15 to 50 ml, but in some cases it can increase several times.

Causes of hydropericardium

Normally, the fluid is produced by the cells that line the pericardium from the inside, and is reabsorbed by them. Its amount increases only in two cases - with increased production or slowed absorption. Such violations may lead to:

• chronic heart failure;
• pericarditis;
• cardiomyopathy;
• congenital malformations of the heart and pericardial sac;
• decrease in the content of blood proteins, which occurs in many diseases;
• hypothyroidism;
• allergy;
• injuries;
• anemia;
• radiation therapy;
• chronic kidney failure;
• tumors of the mediastinum (place in the chest where the pericardium and heart are located).

There are also special forms of hydropericardium in which fluid accumulates and:

• lymph (chylopericardium – a consequence of blocking the flow of fluid through the lymphatic vessels; occurs when malignant tumors metastasize);
• blood (hemopericardium; causes – injuries of the heart or vessels of the pericardium, myocardial infarction, obesity).

Symptoms of hydropericardium

With this syndrome, the manifestation of symptoms does not begin immediately. At first, only the symptoms of the disease that provoked the development of hydropericardium are visible. With a small accumulation of fluid, they do not manifest themselves in any way, but in the process of increasing their number, compression of the heart occurs and the impossibility of its contractions. Main manifestations:

• shortness of breath at rest or with minimal effort;
• frequent pulse;
• edema;
• a decrease in blood pressure due to a decrease in cardiac output;
• paleness of the skin, blueness of the lips and the area between the upper lip and the nose (acrocyanosis of the nasolabial triangle).

With a massive hemopericardium, the vagus nerve adjacent to the esophagus is irritated, painful hiccups may occur. This is a sign of a threat to life, it is necessary to immediately call "Ambulance".

With hemopericardium, as a result of trauma, a critical condition can occur - cardiac tamponade. In this case, the contractions of the heart are not enough to drive blood through the vessels, and a person can die within a few minutes. Specialists of the Dobrobut.сom clinic recommend studying cardiopulmonary resuscitation measures and applying them in similar cases - this is the only chance to save a person before the arrival of specialists. When symptoms of tamponade appear, doctors should be called immediately. Symptoms:

• a sharp decrease in pressure, especially with loss of consciousness;
• lack of air with frequent shallow breathing;
• weakness, darkness in the eyes;
• sensation of heartbeat;
• fear of death, overexcitement

Diagnosis of hydropericardium

Ultrasound is the main method of diagnosing this condition. During echocardiography, a discrepancy between the parietal and visceral leaves of the pericardium, which is normally 5 mm, can be detected in the region of the back wall of the left ventricle of the heart. An increase in this distance indicates the presence of liquid between the leaves. Echodiagnosis criteria for hydropericardium:

• 6-10 mm of leaf divergence is the early stage of hydropericardium;
• 10-20 mm – moderate stage;
• more than 20 mm is a pronounced stage.

In the latter case, an additional puncture of the pericardium is performed with the withdrawal of part of the fluid and the study of its nature (inflammatory exudate, lymph, blood, etc.).

Echocardiography allows detecting hydropericardium in the fetus during pregnancy. In this case, the diagnostician should suspect congenital malformation of the heart in the future newborn or hemolytic disease. In this case, the woman should be thoroughly examined and, if necessary, undergo a course of appropriate treatment under the supervision of specialists.

In addition to ultrasound, other studies will have to be performed to diagnose the causes of hydropericardium:

• X-ray of the chest;
• general analysis of urine and extensive blood analysis;
• the level of thyroid hormones;
• protein level in the blood;
• ECG, etc.

Treatment of hydropericardium

The doctor should pay attention to the underlying disease. Treatment of heart failure, taking drugs containing thyroid hormones, restoring the protein level - all these are methods of treatment of the disease that provoked hydropericardium. Most often, this approach is enough to relieve the patient of such a symptom.

However, situations are possible when there is not enough time to wait for the effect and then it is necessary to supplement the treatment of the main disease by fighting hydropericardium directly. Initially, diuretics are used - potassium-sparing (spironolactone, triamterene, hydrochlorothiazide) or thiazide diuretics (furosemide, torasemide) in combination with potassium preparations. In the absence of a result and with a critical volume of fluid, it is possible to perform a pericardial puncture with pumping out the excess exudate.

Hydropericardium is a symptom or complication. It is necessary to treat the main disease that led to the appearance of this symptom. And it is best to prevent the development of such complications, for which you should consult a doctor for any signs of discomfort in the body.

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Consultation of a cardiologist