Dr. Sylvester Ikhisemojie
The specter of having fluids accumulating around the heart is one that has occupied the attention of many doctors for centuries. In the past, mainly due to a lack of the proper tools to deal with this problem, many people died from it.
However, as far back as 1840, the technique for draining such fluid accumulation was described for the first time but it was not until later in the 19th century that the first successful one was performed. By the 20th century, this had become a routine procedure especially due to an improved understanding of how this process develops. The sac around the heart inside which this fluid accumulates is called the pericardium and it has two walls.
So this malady is more specifically called a pericardial effusion. This medical term, therefore, describes the buildup of any kind of fluid around the heart. As technological advancement throughout the world in the last century sped ahead, so has the outlook improved for the sufferers of this condition. For many victims, therefore, there is more hope today than there was at a comparable time a century ago.
This condition can develop rather quickly, like in as little as one week in an acute condition. When it is described as chronic, it can develop over a period of several months. In many cases, people who have pericardial effusion will not even realise that they have a problem, and the diagnosis is then made by chance when chest x-rays or computerised scanning of the chest then brings the situation into proper visibility.
On the other hand, some other people who have this condition could suffer catastrophic deterioration in the ability of the heart to function normally. At any rate, having this situation is always a serious issue and one that is not to be toyed with.
Therefore, it should always attract the quickest reaction possible in acknowledgment of that course. As a result, the greater aspect of the treatment of the condition is the treatment of the underlying cause. Typhoid fever, diphtheria, and tuberculosis are some of the specific disease conditions that can bring this about.
Some of the causes are often due to infections caused by any kind of micro-organism that you can care to name; these are usually bacteria, viruses, and fungi. Occasionally, parasitic infections would be the cause. Besides, systemic disease conditions usually start from some other part of the body and develop in severity to involve the rest while also ultimately involving the pericardium and hence the heart.
Some of these conditions are kidney failure which allows fluid to accumulate in many parts of the body, autoimmune diseases, systemic lupus erythematosus, rheumatoid arthritis, wounds sustained close to the heart including heart surgery, and the scourge of spreading cancer such as cancer of the breast or of the lungs. The use of certain medicines such as penicillin, minoxidil, and others deployed in the treatment of cancer can provoke similar fluid accumulations around the heart. On the whole, as much as two-thirds of the cases of this nature are probably associated with a known disease condition.
Usually, the pericardium contains between 10 and 50 milliliters of fluid which makes it possible for the heart to glide around that covering sac with ease. There is a similar sac around the lungs and the abdominal cavity.
What this volume means is that the appearance of symptoms in a person who has got this condition depends on how quickly the fluid accumulates. So in the early stages of such an accumulation, there may be no symptoms
at all because this sac can actually stretch. However, as the increase in volume intensifies, it places a certain amount of pressure on neighboring organs such as the heart, lungs, and nerves.
The resulting effects of such pressure are chest pain that gets worse when you lie flat, the feeling of a certain fullness in the abdomen, shortness of breath, and cough. These people will also develop a feeling of nausea and lightheadedness and would proceed to a state of confusion. The voice could become hoarse and hiccups would develop apparently as a result of the involvement of certain nerves. Inability to perform normal exercises can ensue followed by fainting attacks.
As the fluids build up rapidly in that pericardial cavity, so much pressure is exerted on the heart that this organ is no longer able to carry on with its normal functions. This is a situation that threatens life and it is known as cardiac tamponade. In this situation, the person involved will actually drift into a situation where a recognised change in mental state is evident. The lips, fingers, and skin are by this time observed to be blue in colour and the person can go into a state of shock which we discussed on this page about two years ago.
So it turns out that if there are no symptoms as such, the treatment will involve mainly the use of medications targeted at the underlying disease condition and this is usually enough treatment.
On the other hand, if any person has got any of the symptoms mentioned above in connection with a large volume of fluid or its rapid accumulation, it becomes a life-saving measure to drain such fluids. Sometimes, it involves an effort to drain such fluid using a needle that is inserted into the space below the sternum and directed at the left shoulder.
The above procedure is better done with some form of guidance using an electrocardiogram. The fluid obtained can be analysed in a laboratory to help determine its cause and possible origin. It is a risky procedure but can be life-saving if the heart is compressed already by its surrounding sac. As a follow-on procedure, a drain can then be left in place to continue to remove the fluid around the heart. Such an opening is called a pericardial window and it helps a great deal not only to relieve the pressure on the heart itself but also to allow the deployment of medications safely.
Many of these medications help to reduce the inevitable inflammation around the heart, such as paracetamol, ibuprofen, and aspirin but also help with pain relief as well. Antibiotics can then be used judiciously depending on the cause of the infection while drugs known as diuretics are administered especially when the heart has begun to fail. In this way, in particular, the buildup of fluid around the body as a consequence of the heart’s diminished capability as a pump is effectively enhanced.
Questions and answers
Dear doctor, please I need your help. I don’t know what’s wrong with me. I usually forget things and words easily every time. Please help me with the cure. 0814xxxxxxx
Well, you didn’t tell us what kind of work you do and how old you are. If this is a recent problem, then you should visit the hospital for a proper examination because it could have something to do with the pressures you face at work and the volume of responsibilities you are saddled with. However, if you have been like this for a long time, it could be that you are still going to benefit from a proper examination but in that case, there may be nothing wrong other than occasional lapses in attention.
Dear doctor, I have a friend who is a stammerer and I usually take the words off his mouth to save him the trouble of trying to complete a sentence. Please what is the medical explanation for stammering? Is there a medical remedy/cure to assist him? 0812xxxxxxx
Stammering is caused by the failure of the brain to properly integrate the nerves in the production of sound causing it to be repetitive. It may also be caused by emotional problems. It is therefore a disability as it can interfere with effectiveness at work especially when a considerable amount of talking is involved in doing such work. Unfortunately, there is no cure for this condition.
Dear doctor, I heard that a human kidney is $260,000 in the open market but may be cheaper in the black market. Now, an Onitsha man in Europe killed his wife and sold her organs. 0806xxxxxxx
Well it is generally known that the illicit trade in human organs is alive and thriving. It is called the red market and the truth about the human condition is that if there is a demand for something, there will be people to provide it. So this trade has led directly to the death of perhaps hundreds of thousands of people over the last four decades. It started in India in the 1980s and has spread to China, Pakistan, Egypt, and The Philippines. In China, in particular, it is speculated that these organs mostly come from prisoners. So you are correct about the kidney but that is the price for one kidney. The heart costs one million dollars and the liver over half a million US dollars. I have no information about the Onitsha man in Europe who allegedly murdered his wife.
Dear doctor, my wife is 10 weeks pregnant and all of a sudden, she developed severe pain in her left thigh. She cannot walk any reasonable distance without suffering from excruciating pains. She has been given some antimalarial medicine which she completed four days ago but I took her to a hospital where she was admitted and she was placed on drips and some medicines. The pain comes and goes and the thigh is swollen and bigger than the other one but we don’t know what has caused the sudden pain or the swelling. This is her first pregnancy so this is not something that we have experienced before. And earlier last week, she was told that she would need to do an ultrasound scan. What is your advice, please? Thank you very much for your anticipated response. 0812xxxxxxx
The pain and the swelling really make it scary. I believe you may be dealing with something ultimately sinister and you should take your wife away from that hospital for a larger public one where surgeons, obstetricians, and physicians can be found and who will find it easy to do the required investigations to enable them to rule in or rule out the possibility of deep vein thrombosis. If this is the ultimate diagnosis, it can be life-threatening and the treatment she will need is not all to do with these issues of drips and malaria drugs. Make haste please and good luck.
Dear doctor, thank you for the work you are doing. I have been suffering from pains on my right side. The pain is serious and if I eat swallow it gives me a lot of discomfort. I went to a laboratory and they told me that it is an ulcer. I was given some medications and it was reduced. But it has returned and it is more serious than before. What do you think I should do sir? What is your advice? 0817xxxxxxx
Thank you very much for your kind words. It is not clear what kind of tests you did at the laboratory that declared your case as an ulcer. And it is not clear from your history who prescribed the medications you took and what their names are. However, it is important to have proper investigations done preceded by a thorough physical examination. If you get to visit a proper hospital for that kind of attention, a solution to your problem will be found.
Dear doctor, I am a short man being only 152 centimeters tall, which is just under five feet. Is it possible to increase my height? 0807xxxxxxx
This is a big question. It is possible in theory to increase your height. It will involve a number of complicated bone lengthening procedures that will cost you a massive amount of money but will not be acceded to by most doctors because of the unnecessary risks involved. You should not even bother.
Dear doctor, for nearly eight months I have been treating toilet infection with a bad smell and constant vaginal discharge. I am 28 years old and single. What can I do about this? 0803xxxxxxx
What you will do depends a lot on you; you must go to the hospital and get examined properly by a doctor. The doctor will request a number of tests as part of the examination. The results obtained will guide what kind of treatment must be taken. Following the required treatment, follow-up tests are conducted until nothing more is found. As long as an organism is isolated in any test you carry out, treatment will have to be undertaken. You must note that many of these infections people label as toilet infections are actually sexually transmitted infections or due to poor genital hygiene.
All rights reserved. This material, and other digital content on this website, may not be reproduced, published, broadcast, rewritten or redistributed in whole or in part without prior express written permission from PUNCH.
Contact: [email protected]