Hemopericardium refers to

blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the cir ...

in the pericardial sac of the

heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide to t ...

. It is clinically similar to a

pericardial effusion A pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. The pericardium is a two-part membrane surrounding the heart: the outer fibrous connective membrane and an inner two-layered serous membrane. The two layers of t ...

, and, depending on the volume and rapidity with which it develops, may cause

cardiac tamponade Cardiac tamponade, also known as pericardial tamponade (), is the buildup of fluid in the pericardium (the sac around the heart), resulting in compression of the heart. Onset may be rapid or gradual. Symptoms typically include those of obstructi ...

. The condition can be caused by full-thickness necrosis (death) of the myocardium (heart muscle) after

myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may ...

, chest trauma, and by over-prescription of

anticoagulants Anticoagulants, commonly known as blood thinners, are chemical substances that prevent or reduce coagulation of blood, prolonging the clotting time. Some of them occur naturally in blood-eating animals such as leeches and mosquitoes, where they ...

. Other causes include ruptured aneurysm of sinus of Valsalva and other

aneurysm An aneurysm is an outward bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel wall. Aneurysms may be a result of a hereditary condition or an acquired disease. Aneurysms can also be a nidus ( ...

s of the

aortic arch The aortic arch, arch of the aorta, or transverse aortic arch () is the part of the aorta between the ascending and descending aorta. The arch travels backward, so that it ultimately runs to the left of the trachea. Structure The aorta begins ...

.Gray's Anatomy, 1902 ed. Hemopericardium can be diagnosed with a chest

X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

or a chest

ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...

, and is most commonly treated with

pericardiocentesis Pericardiocentesis (PCC), also called pericardial tap, is a medical procedure where fluid is aspirated from the pericardium (the sac enveloping the heart). Anatomy and Physiology The pericardium is a fibrous sac surrounding the heart composed o ...

. While hemopericardium itself is not deadly, it can lead to

, a condition that is fatal if left untreated.

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. In many cases, patients also report feeling chest pressure and have an abnormally elevated

heart rate Heart rate (or pulse rate) is the frequency of the heartbeat measured by the number of contractions (beats) of the heart per minute (bpm). The heart rate can vary according to the body's physical needs, including the need to absorb oxygen and excr ...

Cause

Hemopericardium has been reported to result from various afflictions including chest trauma, free wall rupture after a

, bleeding into the

pericardial sac The pericardium, also called pericardial sac, is a double-walled sac containing the heart and the roots of the great vessels. It has two layers, an outer layer made of strong connective tissue (fibrous pericardium), and an inner layer made of ...

following a type A

aortic dissection Aortic dissection (AD) occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. In most cases, this is associated with a sudden onset of severe chest or ...

, and as a complication of invasive

cardiac The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide to t ...

procedures. Acute

leukemia Leukemia ( also spelled leukaemia and pronounced ) is a group of blood cancers that usually begin in the bone marrow and result in high numbers of abnormal blood cells. These blood cells are not fully developed and are called ''blasts'' or ...

has also been reported as a cause of the condition. Several cases of hemopericardium have also been reported as a side-effect of

. Patients should be made aware of this fact when prescribed these drugs.

Mechanism

Hemopericardium is a condition that affects the cardiovascular system. It typically begins with

accumulating in the

posterior to the

, and eventually expands to surround the entire heart. The fluid build-up then causes pressure within the

to increase. If the pressure becomes greater than the intracardiac pressure of the heart, compression of the adjacent cardiac chambers can occur. This compression, called

, is often associated with hemopericardium and can be fatal if not diagnosed and treated promptly. Early signs of this compression include right atrial inversion during ventricular systole followed by

diastolic Diastole ( ) is the relaxed phase of the cardiac cycle when the chambers of the heart are re-filling with blood. The contrasting phase is systole when the heart chambers are contracting. Atrial diastole is the relaxing of the atria, and ventricu ...

compression of the

right ventricular outflow tract A ventricular outflow tract is a portion of either the left ventricle or right ventricle of the heart through which blood passes in order to enter the great arteries. The right ventricular outflow tract (RVOT) is an infundibular extension of th ...

. There have also been cases reported in which hemopericardium was noted as an initial manifestation of

essential thrombocythemia Essential thrombocythemia (ET) is a rare chronic blood cancer (myeloproliferative neoplasm) characterised by the thrombocythemia, overproduction of platelets (thrombocytes) by megakaryocytes in the bone marrow. It may, albeit rarely, develop into a ...

Diagnosis

Hemopericardium can be diagnosed using echocardiography, a cardiac ultrasound. Chest

X-rays An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nbs ...

are also often taken when hemopericardium is suspected and would reveal an enlarged heart. Other observable signs include rapid

jugular venous distension The jugular venous pressure (JVP, sometimes referred to as ''jugular venous pulse'') is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different for ...

, low blood pressure, and

pulsus paradoxus Pulsus paradoxus, also paradoxic pulse or paradoxical pulse, is an abnormally large decrease in stroke volume, systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less than 10 mmHg. When the drop ...

Treatment

When discovered, hemopericardium is usually treated by

, a procedure wherein a needle is used to remove the fluid from the

. This procedure typically utilizes an 8-cm, 18-gauge needle that is inserted between the

xiphoid process The xiphoid process , or xiphisternum or metasternum, is a small cartilaginous process (extension) of the inferior (lower) part of the sternum, which is usually ossified in the adult human. It may also be referred to as the ensiform process. Bo ...

and the left

costal margin The costal margin, also known as the costal arch, is the lower edge of the chest (thorax) formed by the bottom edge of the rib cage. Structure The costal margin is the medial margin formed by the cartilages of the seventh to tenth ribs. It attac ...

until it enters the

, when it can then be used to drain the fluid from the sac. A

catheter In medicine, a catheter (/ˈkæθətər/) is a thin tubing (material), tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgi ...

is often left in the

pericardium The pericardium, also called pericardial sac, is a double-walled sac containing the heart and the roots of the great vessels. It has two layers, an outer layer made of strong connective tissue (fibrous pericardium), and an inner layer made o ...

to continue draining any remaining fluid after the initial procedure. The catheter can be removed when the hemopericardium no longer persists. The underlying causes of the condition, such as over-prescription of

, must be addressed as well so that the hemopericardium does not return. While hemopericardium itself is not fatal, it may lead to

, which can be deadly if not treated promptly. One study found that

was fatal in 13.3% of cases in which it was not caused by a

malignant Malignancy () is the tendency of a medical condition to become progressively worse. Malignancy is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous ''benign'' tumor in that a malignancy is not s ...

disease A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...

Research

Studies have shown that hemopericardium can occur spontaneously in people with

, although this is relatively rare. It is a more common occurrence in patients who have been over-prescribed

. Regardless of the underlying cause of the hemopericardium,

has shown to be the best treatment method for the condition.

References

External links

{{Bleeding and clotting disorders, us=y Chest trauma Pericardial disorders