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Signs and symptoms of cardiac tamponade

Oct07
2009 Leave a Comment Written by admin

Individuals who experience cardiac tamponade often describe one or more of these symptoms:

* Sharp chest pain, often related to pericarditis, dissipating by the time the more severe cardiac tamponade condition develops

* Shortness of breath, sometimes as a result of breathing shallowly on purpose to avoid chest pain but usually, once cardiac tamponade has developed, related to reduced blood flow

* Forward-leaning posture due to pain and/or the need to catch one’s breath

* Weakness and/or fatigue

* Bluish tint to skin (cyanosis)

* Anxiety

* Swelling in the abdomen

Clinical signs, which may not be directly evident to the patient or through observation, include:

* Falling arterial blood pressure

* Rising venous blood pressure (which causes the distended jugular veins in the neck as returning blood can’t flow into the heart)Tachycardia is an unusually fast heartbeat (more than 100 beats per minute).

* Tachycardias (rapid heart rhythms) and muffled heart sounds

* Narrowed pulse pressure (a decrease in the difference between systolic and diastolic measurements)

* Significant decline of pulse volume and systolic blood pressure during inhalation

Diagnosis methods for cardiac tamponade

Several diagnostic tests can be used to help the physician to diagnose cardiac tamponade and rule out other conditions. Tests typically include:

* Echocardiogram. This test uses sound waves to visualize the structures and functions of the heart. It may reveal a buildup of fluid in the pericardium, abnormal heart movements (a “swinging heart”) and/or a dilated vena cava. Echocardiograms can also be used to exclude other possible causes for the symtoms, including tumors, constrictive pericarditis, cardiomyopathy and blood clots. In addition, a Doppler ultrasound may be done to measure blood flow. This test may show insufficient diastolic (relaxation) activity in the right atrium and right ventricle. It may also reveal heart valve obstruction or leakage as the cause of the bulging neck veins.

Echocardiogram

* Electrocardiogram (EKG). A recording of the heart’s electrical activity as a graph on a moving strip of paper or video monitor. The test, in the presence of cardiac tamponade, often exhibits low electrical voltage.

Electrocardiogram

* Chest x-ray. The x-ray may show an enlarged cardiac “silhouette” due to an excessive volume of pericardial fluid, especially when more than 200 milliliters of fluid has built up in the pericardium.

Treatment and prevention

Acute cardiac tamponade is considered a medical emergency. Diagnostic tests will be performed quickly and comprehensively to determine the appropriate course of treatment. Treatment will focus on the immediate reduction of fluid in the pericardial sac.

The treatment for cardiac tamponade is to aspirate (drain or remove through suction) fluid from the pericardium. This invasive process is known as pericardiocentesis. This technique entails numbing of the chest area with a local anesthetic followed by the insertion of a needle just below the breast bone (sternum) and into the pericardium. The needle is then replaced by a catheter and excess fluid is drained through the tube and into sterile containers.

Often, an echocardiogram is used to help guide the entry of the needle. This use of ultrasound imaging to assist in pericardiocentesis has greatly improved its safety and effectiveness. However, the procedure does have risks, and patients will be under close observation after the procedure. A hospital stay of several days should be expected, to monitor for a re-accumulation of fluid.

If pericardiocentesis is not successful, or if other complications are present, further intervention may be necessary. These procedures include the following:

* Percutaneous balloon pericardiotomy uses a balloon-tipped catheter to create a tear in the wall of the pericardium, through which a drainage tube can be inserted. The procedure only requires local anesthesia. It is most commonly performed in patients whose cardiac tamponade is cancer-related.

* Surgical pericardiotomy involves putting the patient “to sleep” with general anesthesia. The surgeon then makes a cut-down (incision) in the chest and pericardium to gain access for the drainage tube. Surgery is more likely if the fluid continues to re-accumulate, if the cause of the fluid accumulation remains obscure, or if the removal of the pericardial sac becomes necessary.

* Pericardiectomy is a type of operation in which part of the pericardium is surgically removed. This procedure may be done if scarring is present with cardiac tamponade or if a biopsy of the pericardium is necessary.

There are two main prevention strategies for cardiac tamponade, both of which are advised for people at high-risk of developing the condition:

* Taking anti-inflammatory medications (e.g., NSAIDs) to help prevent any fluid buildup in the pericardium from progressing to cardiac tamponade

* Learning the warning signs and symptoms of fluid buildup in the pericardium (pericardial effusion) and contacting a physician immediately if any of these are experienced.

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Cardiac Tamponade

Oct07
2009 Leave a Comment Written by admin

Cardiac tamponade is an uncommon condition characterized by the accumulation of fluid in the pericardium (the sac surrounding the heart). This fluid can put so much pressure on the heart that it is unable to pump enough blood to meet the body’s demands. Fluid accumulation in the pericardial sac is known as pericardial effusion. Cardiac tamponade results when fluid collects rapidly or in large amounts, which interferes with the heart’s ability to pump and fill with blood.

Cardiac tamponade can be caused by trauma (such as a car accident), a coronary event (such as a heart attack) or cancer. Among the most common causes of tamponade are inflammation of the pericardium (pericarditis) and toxic accumulation in the blood, which is usually a result of kidney disease. However, other conditions may cause it as well.
Cardiac Tamponade

Treatment for cardiac tamponade involves removing the fluid from the pericardium, which may be done with a needle and catheter combination (pericardiocentesis), balloon-tipped catheter or surgery. People at high risk for developing cardiac tamponade are urged to take anti-inflammatory medications and to learn the symptoms of cardiac tamponade in order to get immediate medical treatment at the first sign of danger. READ MORE »

Posted in Effects of Aging

Aging Heart

Sep10
2009 Leave a Comment Written by admin

Our Heart

The heart, one of the vital organs in the human body, is a powerful pump located behind and slightly to the left of the breastbone and between the lungs. It is a muscle about the size of your fist which contracts and expands using its own bio-electrical system, to continuously pump blood around the body to nourish and provide energy. The pumping of the heart is known as the cardiac cycle, which occurs about 72 times per minute and it pumps blood through network of vessels in the body.

The heart lies at the centre of these complicated network of blood vessels which include arteries and veins. The left side of the heart  receives oxygen filled blood from the lungs and pumps it out through the ‘arteries’ around the body and the right side receives used up-blood containing carbon dioxide through the ‘veins’ and sends this blood to the lungs to get rid of the carbon dioxide and take in fresh oxygen.

The heart, in the simplest terms, consists of four chambers, two atria (upper chambers) and two ventricles (lower chambers).  As the muscles of the heart relax, blood (oxygen filled blood from the lungs and carbon dioxide filled blood from the rest of the body) enters its various chambers. The atrium fill with blood and help move blood into the ventricle. The ventricle supplies the main force that pumps the blood out, through either the lungs or to the rest of the body.  As the blood enters the heart, Flaps called valves close quickly to stop any blood leaking backwards and thus control the direction of blood flow. There are four valves; mitral and the tricuspid between the atria and the ventricles and other two, aortic and pulmonary through which blood enters and leaves the heart.

Effects of aging
Heart functions begin to slow down with age. The aging process reduces the heart muscle strength. So its pumping power declines, and the maximal heart rate (the highest number of times your heart can contract in a minute) also decreases. When the amount of blood pumped by the heart in a minute declines, systolic blood pressure tends to rise. Some of the common heart problems that can occur as we age are

Arteriosclerosis (hardening / clogging of the arteries due to excessive build up of fat and cholesterol known as plaque). Fatty plaque deposits inside the blood vessels cause it to narrow and can totally block blood vessels and also cause the valves that control the direction of blood flow to thicken and become stiff. Arteriosclerosis in turn is the underlying cause of most cardio vascular diseases.

The heart has to work harder due to decreased blood supply. Greater force is necessary to push blood through narrowed vessels due to plaque build up. So high blood pressure develops and this buildup and shortage of oxygenated blood over time, leads to heart attacks. In a heart attack, a part of the heart muscle becomes starved for oxygen and dies.

Angina (chest pain caused by temporarily reduced oxygenated blood flow to the heart muscle), causing pain in the chest, in the left arm or between the shoulder blades.

Dissecting Aneurysm:  The atherosclerosed aorta becomes brittle and can break much easier creating a life threatening situation.

Heart failure is very common in the elderly. In people older than 75, heart failure occurs 10 times more often than in younger adults.

Abnormal heart rhythms (arrhythmias) of various types.

Probable reasons for the change…

From forty through seventy, the five major risk factors for heart disease are family history, smoking, high cholesterol, diabetes and high blood pressure. But apart from family history and smoking, the others are related to diet, weight and inactivity. Directly, age is not a risk factor but people tend to put on weight and become more inactive as they age and a combination of other factors like continuing heart-unhealthy habits and diets takes its toll as people age and as such age is a risk factor for the other risk factors. Apart from cholesterol; stress and the presence of Lp (a), a lipoprotein; homocysteine, an obscure amino acid ; and triglycerides, a compound of fats in the blood are also involved in the development of heart diseases. Your triglyceride levels tend to rise from forties through sixties. The higher the levels of triglycerides, the higher the probability of reduced levels of good cholesterol (HDL). The body also converts the cellular carriers of triglycerides into forms of bad cholesterol (LDL).

Ways to delay effects of aging…

Risk factors that you have some control over include high blood pressure, cholesterol levels, diabetes, obesity, and smoking. ‘Atherosclerosis’ once thought to be an aging disorder is now known to be  a progressive narrowing of arteries over time which is fed by rich diets, high in cholesterol and fats and aggravated by smoking and high blood pressure.

People who work out seriously and continuously for most of a decade has been seen to cut their age related decline of  maximal heart rate in half.  So maintaining a healthy diet and regular activity level and stopping unhealthy habits like smoking go a long way in controlling heart related problems.

Check ups
Age 35 is a good time to get your blood checked out, especially your cholesterol levels ( a base level blood count and a  full lipid profile) and blood  pressure, and have a follow up every other year.  Consider getting a CT scan  at 40, if there is a  strong incidence of heart  disease or heart attack in your family.  People aged 30 and older, who are more prone for a heart disease risk, like people having a sudden new pain, and those who are smokers and have a family history of diabetes or have diabetes should have a baseline ECG Test .

Smoking
Minimize or quit smoking. Smoking and tobacco-related health complications are the single largest cause of preventable, premature death.  The prime ingredients in cigarettes such as tar, carbon monoxide and nicotine are instigators of cardiovascular diseases and lung ailments.

Diet
Eat a heart-healthy diet with reduced amounts of saturated fat and cholesterol and rich in unrefined, complex carbohydrates. Heart disease often begins in childhood by consumption of heart unhealthy diets from a young age and fatty deposits getting accumulated in the arteries. Lesions in the arteries often appear in young people following this unhealthy regimen. A sustained low fat vegetarian diet which consists of fruits, vegetables, grains, legumes, soya bean products and yoghurt etc along with regular exercise, stress management, non-smoking etc has been proved to even regress arterial fatty deposits of patients with heart disease. Dietary practices recommended to reduce the risk of heart disease includes

Keep fat intake below 30 percent of your total calories. Try to avoid fried food stuffs and also food that contain excess fat such as beef, mutton etc.

Within the recommended fat intake,  less than 10% should come from saturated fat. i.e 25 gm for women and 30gm for men. A slice of cheese, a pat of butter, one half cup of milk contains about 5gm of fat.

50 to 60%  of your total calories should come from carbohydrates such as rice, bread, potatoes and pasta.

Limit the cholesterol in your diet to 300milligrams or less, a day. Eggs, meat and diary products are major sources of cholesterol. One egg yolk contains about 220 milligrams of choleterol.

Reduce the amount of salt intake.

Eat raw vegetables such as cucumber, carrot, tomato, onion etc as also foods with more fibre content.

Excercise
Moderate exercise is one of the best things you can do to keep your heart and the rest of your body, healthy. Consult with your health provider before beginning a new exercise program. Exercise moderately and within your capabilities, but do it regularly. Exercise helps reduce stress and prevent obesity which in turn is associated with the development of heart disease, diabetes etc. It also helps people with diabetes control their blood sugar.

People who work out seriously and continuously for most of a decade has been seen to cut their age related decline of  maximal heart rate in half. Between ages 40-50 check out your VO2 max, the maximum rate at which the muscles use oxygen during peak exercise.  The old standard for calculating your target heart rate is (220- your age) x .85. For good cardio fitness, it is advisable to exercise aerobically 90 minutes per week minimum.

Drinking
Alchohol (Ethyl alcohol or ethanol) made out of Fermented grain, fruit juice and honey is a depressant, and if taken in small amounts relaxes the mind and reduce anxieties. More and more studies have shown that ethanol increases levels of HDL cholesterol (the good stuff) , dilates blood vessels and keeps blood from clotting. But no more than two drinks per day is beneficial and more than that could be detrimental for health.

Posted in Effects of Aging