Hemopericardium

Hemopericardium refers toblood in thepericardial sac of theheart. It is clinically similar to apericardial effusion, and, depending on the volume and rapidity with which it develops, may causecardiac tamponade.^[1]

The condition can be caused by full-thicknessnecrosis (death) of themyocardium (heart muscle) aftermyocardial infarction,chest trauma,^[2] and by over-prescription ofanticoagulants.^[3][4] Other causes include rupturedaneurysm of sinus of Valsalva and otheraneurysms of theaortic arch.^[5]

Hemopericardium can be diagnosed with a chestX-ray or a chestultrasound, and is most commonly treated withpericardiocentesis.^[6] While hemopericardium itself is not deadly, it can lead tocardiac tamponade, a condition that is fatal if left untreated.^[6]

Symptoms and signs

Symptoms of hemopericardium often include difficulty breathing, abnormally rapid breathing, and fatigue, each of which can be a sign of a serious medical condition not limited to hemopericardium.^[6] In many cases, patients also report feeling chest pressure and have an abnormally elevatedheart rate.^[7]

Cause

Hemopericardium has been reported to result from various afflictions includingchest trauma, free wall rupture after amyocardial infarction, bleeding into thepericardial sac following a type Aaortic dissection, and as a complication of invasivecardiac procedures.^[6] Acuteleukemia has also been reported as a cause of the condition.^[7] Several cases of hemopericardium have also been reported as a side-effect ofanticoagulants.^[6] Patients should be made aware of this fact when prescribed these drugs.^{[citation needed]}

Mechanism

Hemopericardium is a condition that affects thecardiovascular system. It typically begins withblood accumulating in thepericardial sac posterior to theheart, and eventually expands to surround the entire heart.^[6] The fluid build-up then causes pressure within thepericardial sac to increase. If the pressure becomes greater than the intracardiac pressure of the heart, compression of the adjacent cardiac chambers can occur.^[6] This compression, calledcardiac tamponade, is often associated with hemopericardium and can be fatal if not diagnosed and treated promptly.^[6] Early signs of this compression include right atrial inversion duringventricularsystole followed bydiastolic compression of theright ventricular outflow tract.^[6]

There have also been cases reported in which hemopericardium was noted as an initial manifestation ofessential thrombocythemia.^[7]

Diagnosis

Hemopericardium can be diagnosed usingechocardiography, acardiac ultrasound.^[6] ChestX-rays are also often taken when hemopericardium is suspected and would reveal anenlarged heart.^[6]

Other observable signs include rapidheart rate,jugular venous distension, lowblood pressure, andpulsus paradoxus.^[6]

Treatment

When discovered, hemopericardium is usually treated bypericardiocentesis, a procedure wherein a needle is used to remove the fluid from thepericardial sac.^[6] This procedure typically utilizes an 8-cm, 18-gauge needle that is inserted between thexiphoid process and the leftcostal margin until it enters thepericardial sac, when it can then be used to drain the fluid from the sac.^[6] Acatheter is often left in thepericardium to continue draining any remaining fluid after the initial procedure.^[7] The catheter can be removed when the hemopericardium no longer persists. The underlying causes of the condition, such as over-prescription ofanticoagulants, must be addressed as well so that the hemopericardium does not return.^{[citation needed]}

While hemopericardium itself is not fatal, it may lead tocardiac tamponade, which can be deadly if not treated promptly. One study found thatcardiac tamponade was fatal in 13.3% of cases in which it was not caused by amalignantdisease.^[8]

Research

Studies have shown that hemopericardium can occur spontaneously in people withessential thrombocythemia, although this is relatively rare.^[7] It is a more common occurrence in patients who have been over-prescribedanticoagulants.^[6] Regardless of the underlying cause of the hemopericardium,pericardiocentesis has shown to be the best treatment method for the condition.^[6][7]

References

External links

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• Chest trauma
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