CARDIAC TAMPONADE (fr. tamponnade, from tampon a plug, a stopper) — a syndrome of the acute heart failure caused by an intra pericardiac prelum of heart liquid or gas.
T. the page is among serious and dangerous conditions. It develops at hemopericardium (see), the T is more rare. the page meets at nek-ry forms of exudative pericardis (see), proceeding with bystry accumulation of exudate, at pneumopericardium (see).
Disturbances of an endocardiac hemodynamics at T. pages are caused first of all sdavleniyekhm thin-walled departments of heart, leading to reduction of filling of his cavities. The increasing pressure in a pericardiac cavity sharply worsens inflow of blood to heart that leads to development of a syndrome of low cordial emission (sharp reduction of cardiac and shock volumes of heart, narrowing of peripheral vessels, reduction of a fabric blood-groove, an oliguria, increase in oxygen consumption and increase in content in blood milk and pyroracemic to - t).
The expressed picture T. the page develops at acute accumulation in a pericardiac cavity of 150 — 200 ml of liquid. Patients show complaints of hl. obr. on feeling of compression and a stethalgia, sensation of fear. Pale coloring of face skin is replaced by sharp cyanosis. Swelling of saphenas of a neck, perspiration, an asthma, increase in the sizes of a liver are noted. The cardiac impulse is not defined, limits of cordial dullness are expanded, cardiac sounds deaf, hypotension is expressed and the central venous pressure is increased. Pulse is soft, weak filling, it is probed generally only on large arteries (humeral, sleepy, femoral). At considerable accumulation of liquid in a pericardiac cavity paradoxical pulse sometimes appears (easing or disappearance of pulse wave on a breath). The ECG has a low voltage with alternation of the QRS complexes.
At rentgenol. a research the expansion and smoothing of contours of a shadow of heart connected with availability of liquid in a pericardiac cavity come to light; reduction of amplitude of reductions of ventricles of heart. By means of radio angiocardiography reveal the signs inherent to availability of liquid in a pericardiac cavity — a «dark» zone directly at heart and horseshoe «luminescence» in a pericardiac cavity.
Diagnostic, and in some cases and medical, value at T. the pericardiocentesis has page. The most widespread is the technique of a puncture developed by A. A. Travin and B. I. Gorokhovsky. In position of the patient lying on spin with the raised trunk (a corner between the plane of a table and a back — 30 — 40 °), under local anesthesia a needle, length cover 100 — 120 mm and diameter of 1 — 1,5 mm, do in a stake in an interval between a xiphoidal shoot of a breast and the left costal arch. Then the needle is advanced to the parallel-left costal arch at an angle 20 — 25 °, carrying out trial suctions by the syringe. The needle is advanced before receiving liquid from a pericardiac cavity. At the large volume of liquid the pericardiocentesis can be made also in the fifth mezhre-berye on the parasternal (eye-logrudinnoy) line at the left.
Differential diagnosis carry out with cardiogenic shock (see) and internal bleeding (see).
At T. the page, caused by wound of heart, in most cases is necessary an urgent operative measure with sewing up of the damaged walls of heart. Waiting tactics is possible only at the hemopericardium which arose after carrying out an endocardiac research or heart operation. In these cases the puncture of a pericardiac cavity can lead to improvement of a condition of patients and the termination of further accumulation of liquid in it. In the absence of effect an operative measure is necessary.
Cardiac glycosides, diuretics can be used only at the accruing cardiac tamponade connected with an exudative pericardis. Introduction of inotropic means at the cardiac tamponade caused by bleeding strengthens it and makes heavier a condition of the patient.
Forecast the hl depends. obr. from an etiology of T. page. Longevity after the cardiac tamponade caused by its gap is estimated for minutes, is more rare for hours. At T. the page because of wounds of heart an outcome depends on timeliness of an operative measure.
Bibliography: Travin A. A. and Gorokhovsky B. I. Subksifoidalnaya a pericardiocentesis for diagnosis of an acute haemo cardiac tamponade, Grudn. hir., JVft 4, page 39, 1968.
A. D. Levant.