Ingabe isifuba sakho sibuhlungu? Ingabe kunzima ukuphefumula? Lokhu kungaba yi-Acute Pericarditis!

Wake wazizwa unesicanucanu ngokuzumayo, waba nobuhlungu esifubeni, futhi waba nobunzima bokuphefumula? Mhlawumbe ubuhlungu buya ngokuba bubi kakhulu uma ulala phansi, futhi bube ngcono uma ugoba phambili? Uma unalezi zimpawu, kungaba ukuvuvukala kwe-pericardium, odokotela abayibiza ngokuthi i-Acute Pericarditis . Ungakhathazeki, sizoxoxa ngalokhu ngendlela elula ongayiqonda.

Kuyini i-Acute Pericarditis?

Kalula nje, i-acute pericarditis ukuvuvukala, noma ukuvuvukala, kwe -pericardium , isikhwama esizungeze inhliziyo. Ngokuvamile kubangela ubuhlungu besifuba, okungaba kubi kakhulu uma ulala phansi noma uphefumula kakhulu. Izindaba ezinhle ukuthi ingelashwa kaningi, kuye ngokuthi imbangela iyini, futhi abantu abaningi abanalesi simo bayalulama ngaphandle kwezinkinga ezinkulu.

Ngakho-ke iyini le pericardium?

Cabanga ngakho, inhliziyo yethu ifana negugu eliyigugu. Kukhona isikhwama esincane esizungeze leli gugu ukuze silivikele. Leso sikhwama sibizwa ngokuthi i-pericardium . Lesi isikhwama esinezingqimba ezimbili. Lokhu kusiza ukugcina inhliziyo isendaweni eyodwa ngaphakathi kwesifuba sethu. Futhi, kukhona ungqimba oluncane loketshezi phakathi kwenhliziyo nongqimba lwangaphakathi lwalesi sikhwama. Lolu ngqimba loketshezi lunciphisa ukungqubuzana okwenzeka lapho inhliziyo ishaya. Ukuze kube sobala, luhlinzeka ngesivikelo kanye nokusekelwa okufana nomcamelo enhliziyweni. Kodwa-ke, kungenzeka ukuphila ngaphandle kwe-pericardium. Abanye abantu bazalwa bengenayo i-pericardium, kanti abanye baphila impilo enempilo ngisho noma isusiwe ngokuhlinzwa.

Lesi simo siyithinta kanjani imizimba yethu?

Ngokuvamile, kunesikhala esanele ngaphakathi kwale pericardium ukuze inhliziyo igcwale igazi futhi ikhule ngesikhathi sokushaya kwenhliziyo. I-Pericarditis iyodwa ayiyona into enkulu. Kodwa-ke, ingabangela izinkinga eziyingozi. Uyazi ukuthi kanjani? Inkinga yenzeka lapho uketshezi luqoqana ngaphakathi kwe-pericardium - esikubiza ngokuthi i-pericardial effusion - futhi lolo ketshezi luqala ukucindezela inhliziyo.

Cabanga nje, lapho i-pericardium ivuvukala futhi igcwele uketshezi, isikhala senhliziyo siyancishiswa. Uma lokhu kwenzeka, ngezinye izikhathi i-pericardium iyanwebeka, ivumela uketshezi olwengeziwe ukuthi lungene futhi inhliziyo ishaye kahle. Kodwa uma lokhu kwenzeka ngokuzumayo, ngokushesha, uketshezi lucindezela inhliziyo. Khona-ke inhliziyo ayinayo indawo eyanele yokukhula, ngakho ayikwazi ukugcwala igazi kahle. Lokhu kunciphisa inani legazi inhliziyo engalipompa. Lesi simo sibizwa ngokuthi i-cardiac tamponade . Lesi yisimo esiphuthumayo sezokwelapha esisongela impilo. Le tamponade ingabangela inhliziyo ukuthi ime, futhi ingabulala ngemizuzu embalwa.

Ubani ongatshala kangaka?

I-Acute Pericarditis ingenzeka kunoma yimuphi ubudala, kodwa ivame kakhulu kwabesilisa. Ivame kakhulu nakubantu abaneminyaka ephakathi kuka-20 no-50.

Sivame kangakanani lesi simo?

I-acute pericarditis yisimo esivame kakhulu , esibalelwa ku-5% kuphela weziguli ezifika emnyangweni wezimo eziphuthumayo zinobuhlungu besifuba.

Ziyini izimpawu zalokhu?

I-Acute Pericarditis ingaba nezimpawu eziningana. Ezinye zezimpawu zincike embangela eyinhloko. Izimpawu ezingaba khona zifaka:

• Ubuhlungu besifuba (sizoxoxa kabanzi ngalokhu ngezansi).
• Imfiva .
• Ubunzima bokuphefumula (i-Dyspnea).
• I-Tachycardia noma ukushaya kwenhliziyo - lokhu kusho ukuzwa inhliziyo yakho ishaya ngaphandle komzamo.
• Ubuhlungu bemisipha (njengokutheleleka ngegciwane), ikakhulukazi ezinsukwini ezimbalwa ezedlule.
• Ukuqunjelwa noma ubunzima bokugwinya (i-Dysphagia).
• Ukukhwehlela okomile .

Ake sifunde ngqo ngobuhlungu besifuba.

Uphawu oluyinhloko lwe-acute pericarditis ubuhlungu besifuba . Nakuba lobu buhlungu bufana kakhulu nobuhlungu besifuba obwenzeka ngesikhathi sokuhlaselwa yinhliziyo, kunezimo ezithile ezibalulekile. Ubuhlungu obuvela kwi-acute pericarditis buvame ukuba nalezi zici:

• Ukuqala okusheshayo: Lesi sibonakaliso singavela ngokushesha kakhulu, kube nobuhlungu obuphelele phakathi nehora noma amabili.
• Kungahluka kumuntu nomuntu: lobu buhlungu bungaba bukhali kwabanye, futhi bube buthuntu kwabanye.
• Ukusabalala ezindaweni ezizungezile: Njengoba kunjalo ngokuhlaselwa yinhliziyo, lobu buhlungu buvame ukusabalala ezingxenyeni zomzimba ezizungezile.
• Izinguquko ngesimo sakho: Ubuhlungu obukhulu be-pectus buvame ukuba bubi kakhulu uma ulele phansi futhi bube ngcono uma uhlala phezulu noma ugoba phambili . Lokhu kungenye yezimpawu eziyinhloko ezingabuhlukanisa nobuhlungu bokuhlaselwa yinhliziyo.

Ezinye izimpawu

Ezinye izimpawu zingase zivele nge-acute pericarditis. Kodwa-ke, zincike esimweni esiyisisekelo. Okusho ukuthi, i-pericarditis ingase ibangelwe esinye isifo, kanti i-pericarditis ingase ibangele ezinye izimpawu.

Yini ebangela lokhu?

Kunezimbangela eziningi ezingaba khona ze-acute pericarditis. Ezinye zezimbangela ezingaba khona zifaka:

• Ukutheleleka: Lokhu kufaka phakathi ukutheleleka ngamagciwane, ikakhulukazi isifo sofuba , kanye nokutheleleka ngamagciwane njenge- HIV . Isikhunta noma amagciwane nakho kungabangela i-peritonitis, kodwa ukutheleleka okunjalo akuvamile kakhulu.
• Umdlavuza: Umdlavuza we-pericardial ungenzeka, kodwa awuvamile. I-pericarditis ingavela futhi uma amangqamuzana omdlavuza ekhula kwenye indawo emzimbeni futhi asakazekele e-pericardium.
• Izifo zesimiso somzimba noma izimo zokuvuvukala: Isibonelo , i-lupus ,Izimo ezifana ne-rheumatoid arthritis noma i-Sjögren's syndrome .
• Izinkinga noma izinkinga zama-hormone: Izinto ezifana ne -hypothyroidism kanye ne-ovarian hyperstimulation syndrome.
• Ukulimala: Ukulimala esifubeni (njengokushaywa noma inxeba elihlabayo njengommese noma inxeba lokudutshulwa) kungabangela ukuthi i-pericardium ilimale futhi ivuvuke.
• Izifo zenhliziyo noma izinkinga zesistimu yokujikeleza kwegazi: Izimo ezinjengokuhlaselwa yinhliziyo noma ukuhlukaniswa kwe-aorta .
• Izimbangela zezokwelapha: I-acute pericarditis ingenzeka ngemva kokuhlinzwa kwenhliziyo, ukwelashwa ngemisebe yomdlavuza, noma njengomphumela ongemuhle wemithi ethile.
• Ezinye izimbangela: I-Acute pericarditis ingenzeka ngezimo ezifana nokwehluleka kwenhliziyo, isifo sezinso esingamahlalakhona noma ukwehluleka kwezinso, i-cirrhosis yesibindi, noma ngaphandle kwesizathu esaziwayo (idiopathic) .

Ingabe lokhu kuyathelelana?

Nakuba i-acute pericarditis ingabangelwa ukutheleleka okuthelelanayo, awukwazi ukusabalalisa lesi simo noma ukusithola komunye umuntu.

Ukubona kanjani lokhu?

Udokotela angakwazi ukuxilonga i-acute pericarditis ngokusekelwe emlandweni wakho wezokwelapha, izimpawu, ukuhlolwa ngokomzimba, kanye nenhlanganisela yezivivinyo zokuxilonga kanye nezivivinyo zelebhu.

Ngokuvamile, izimpawu ezimbili noma ngaphezulu kwezinhlanu ezilandelayo kumele zibe khona ukuze kutholakale lokhu:

• Ubuhlungu besifuba.
• Ukuhlikihla kwe-pericardial friction: Lona umsindo wokuhlikihla kwe-pericardium yakho ngaphakathi kodonga lwesifuba sakho. Lo msindo awuvamile ukuzwakala. Udokotela angawuzwa lo msindo uma elalele ukuphefumula kwakho nge-stethoscope.
• Izinguquko emsebenzini kagesi: Umsebenzi kagesi wenhliziyo yakho wenzeka ngendlela ethile. Lokhu kungatholakala nge- electrocardiogram (ECG noma EKG) . Ku-acute pericarditis, i-ECG ikhombisa izinguquko ezithile ezihlala izinsuku eziningi, ngezinye izikhathi amasonto.
• Ukuphuma okusha noma okwandayo kwe-pericardial effusion: Lokhu kusho ukunqwabelana okusha koketshezi ngaphakathi kwe-pericardium noma ukwanda kwenani loketshezi olukhona kakade.
• I-Pericarditis: Lokhu kungabonakala ezithombeni ezikhethekile ze-MRI yenhliziyo kanye/noma ekuhlolweni kwegazi.

Yiziphi izivivinyo ezenziwayo ukuze kutholakale lesi simo?

Kunezivivinyo eziningi ezingasiza ekuxilongeni i-acute pericarditis. Izivivinyo ozenzayo zizoncika ezimpawini zakho, izinsolo zikadokotela wakho, kanye nezinye izimo zempilo onazo. Izivivinyo ezingenziwa zifaka:

Ukuhlolwa kwelebhu

Lokhu kuhlolwa kubheka izinguquko egazini lakho kanye nezimpawu zezifo ezithile. Lokhu kuvame ukufaka:

• Inani legazi eliphelele elinomehluko.
• I-Troponin.
• Iphrotheni e-C-reactive (CRP).
• Izinga lokusatshalaliswa kwe-erythrocyte (ESR).
• Ukuhlolwa kwamasosha omzimba ukuhlola izifo ezihlasela amasosha omzimba.
• Ukuhlolwa kwe-Tuberculin ukuhlola isifo sofuba .
• Ukuhlolwa kwegazi ukuze kuhlolwe ukutheleleka ngamagciwane.
• Izinga le-urea nitrogen egazini (BUN) kanye nokuhlolwa kwe -creatinine clearance .

Ukuhlolwa kokuxilonga

Lezi zivivinyo zinganquma ukuthi une-acute pericarditis futhi zinikeze izinkomba ezibalulekile zokuthi kungani ivele.

• I-Electrocardiogram (ECG noma EKG): Lokhu kuhilela ukubeka izinzwa ezibizwa ngokuthi ama-electrode (ngokuvamile ayi-10) esikhumbeni sesifuba bese kuqoshwa umsebenzi kagesi wenhliziyo njengamagagasi ephepheni noma esikrinini. Odokotela bangabheka la magagasi ukuze bathole ukuthi kukhona yini ukuphazamiseka.
• I-Pericardial biopsy: Ukuthatha isampula yezicubu ku-pericardium nokuzihlola ngezinye izikhathi kungasiza ekutholeni imbangela eyinhloko.
• I-Pericardiocentesis: Lena inqubo yokususa uketshezi oluningi esikhwameni se-pericardial uma une -pericardial effusion kanye/noma i-cardiac tamponade . Ukuhlaziya lolu ketshezi kungasiza futhi ekutholeni ukuthi yini eyabangela lesi simo kwasekuqaleni.

Ukuhlolwa kwezithombe

Ezinye izivivinyo zokuthatha izithombe zingabona i-pericarditis ebukhali, kanti ezinye zingabona kuphela izinkinga ezingase zivele kuyo. Izivivinyo zokuthatha izithombe ezingenziwa zifaka:

• Ama-X-ray esifubeni.
• I-computerized tomography (CT) scan.
• Ukuthwebula izithombe ze-magnetic resonance (MRI).
• I-Echocardiogram.

Kungelashwa kanjani lokhu? Ingabe kungelapheka?

Ukwelashwa kwe-acute pericarditis kuncike embangela. Uma kukhona imbangela ethile eyisisekelo, ukwelashwa kuzoqondiswa kuleyo mbangela kanye nezimpawu ezibangela i-pericarditis. Udokotela wakho ungumuntu ongcono kakhulu wokukuchazela lokhu, njengoba engakwazi ukwenza ukwelashwa kuhambisane nesimo sakho.

Uhlobo luni lomuthi noma ukwelashwa olusetshenziswayo?

Uma odokotela bengakwazi ukuthola imbangela ethile ye-acute pericarditis, ukwelashwa kugxile ekulawuleni izimpawu.

Okukodwa noma ngaphezulu kwalokhu okulandelayo kungasetshenziswa ukwelapha lezi zimpawu:

• Imithi: Imithi elwa nokuvuvukala engeyona eye-steroidal (ama-NSAID) ivame ukuba yindlela yokuqala yokwelapha. Izibonelo zifaka phakathi i-ibuprofen ne -aspirin . I-Colchicine ingenye imithi elwa nokuvuvukala enikezwa kanye nama -NSAID . Uma lokhu kungasebenzi, ama-steroid ayindlela yokukhetha. Kodwa-ke, lokhu kuza nengozi ephezulu kancane yemiphumela emibi. Udokotela wakho angase futhi akunikeze imithi yokuvikela ulwelwesi lwesisu sakho, njengoba ukusetshenziswa okuqhubekayo kwama-NSAID kungalimaza. Uma imithi eshiwo ngenhla ingazisizi izimpawu zakho, udokotela wakho angase akuncome uhlobo lomuthi olubizwa ngokuthi i-biologics . Lena imithi enamandla, kodwa ingaba nemiphumela emibi. Kungumqondo omuhle ukubuza udokotela wakho ukuthi lokhu kwelashwa kulungile yini kuwe.
• I-Pericardiocentesis: Le nqubo iwusizo uma ukuphuma kwegazi enhliziyweni kuvele ngenxa ye-pericarditis ebukhali, ikakhulukazi uma imbangela eyinhloko iwukutheleleka noma umdlavuza.
• Ukuhlinzwa (Pericardiectomy): Ezimweni ezingavamile, i-pericarditis ingadala umonakalo omkhulu ku-pericardium kangangokuthi inketho engcono kakhulu ukuyisusa ngokuhlinzwa. Lokhu kuhlinzwa, okubizwa ngokuthi i-pericardiectomy, kususa ingxenye noma yonke i-pericardium. Kungenzeka ukuphila ngaphandle kwe-pericardium ngaphandle kwemiphumela emibi yesikhathi eside.

Udokotela wakho angase futhi akucebise ukuthi ushintshe isimiso sakho sansuku zonke futhi uphumule uze ululame kulesi simo.

Yiziphi izinkinga/imiphumela emibi yokwelashwa?

Izinkinga ezingaba khona ngenxa yokwelashwa zincike ekwelashweni okutholayo, ikakhulukazi imithi. Udokotela wakho angakuchaza kangcono lokhu kanye nezinkinga ezingaba khona. Angakuqondisa nokuthi yini ongayenza ukuze ugweme lezi zinkinga nokuthi yini okufanele uyenze uma zenzeka.

Ngingazinakekela kanjani futhi ngiphathe izimpawu zami?

Ngenxa yokuthi izimpawu zifana nokuhlaselwa yinhliziyo, ungazami ukuzixilonga noma ukuzisingatha ngokwakho ngaphandle kokubona udokotela.Ukuhlaselwa yinhliziyo kuyisimo esiphuthumayo sezokwelapha esisongela impilo, ngakho-ke uma uzwa ubuhlungu esifubeni, ake sithi ukuhlaselwa yinhliziyo. Ngaphandle kokuthi kuyi-Acute Pericarditis, ukulibazisa ukwelashwa kokuhlaselwa yinhliziyo kungabangela umonakalo ongapheli enhliziyweni yakho.

Okubalulekile: Uma uzwa ubuhlungu esifubeni, funa iseluleko sikadokotela ngokushesha, ngoba kungaba ukuhlaselwa yinhliziyo. Ungazihlolisisi.

Ngizozizwa ngingcono ngokushesha kangakanani ngemva kokwelashwa?

Kuye ngokuthi isimo sakho sibucayi kangakanani, imbangela eyinhloko, kanye nokwelashwa okusetshenziswayo, isikhathi esithathayo ukuze ululame kwi-Acute Pericarditis sizohluka. Ngokuvamile, abantu abaningi baqala ukuzizwa bengcono ngemva kwesonto elilodwa kuya kwamathathu lokwelashwa , kodwa kungathatha izinyanga ukuze balulame ngokugcwele.

Ngingakuvimbela kanjani lokhu?

I-Acute Pericarditis yisimo esingenakuvinjelwa ngoba senzeka ngokungazelelwe. Okuwukuphela kwento ongayenza ukunciphisa ingozi yakho ngokugwema izimo noma izimbangela ezingayibangela.

Ngingayinciphisa kanjani ingozi yami?

Okuwukuphela kwendlela yokuvimbela i-peccaditis ukugwema izinto ezingayibangela. Nazi ezinye izindlela ongakwenza ngazo lokhu:

• Thola ukwelashwa kokutheleleka ngamagciwane: Ukutheleleka ngamagciwane okungelashwa kungabangela umonakalo omkhulu emzimbeni wakho, ikakhulukazi inhliziyo yakho nezitho eziseduze. Uma usola ukuthi unesifo samagciwane, kubalulekile ukuthi sixilongwe futhi selashwe ngokushesha.
• Gwema ukulimala: Ukusebenzisa imishini yokuphepha efanele, ikakhulukazi ukubopha ibhande lesihlalo lapho ugibela emotweni, kuyindlela eyinhloko yokuvimbela ama-peccadillos acute ekulimaleni esifubeni. Lokhu kuhlanganisa nokuqaphela lapho usebenza ngamathuluzi noma imishini engabangela ukulimala okukhulu esifubeni.
• Landela imiyalelo kadokotela wakho: Ukubona udokotela wakho njengoba kunconywa, kanye nokuphuza imithi/ukwelashwa kwakho njengoba kuyalelwe, kungasiza ekuvimbeleni i-peritonitis yakho ukuthi ingaphinde ivele noma ibe yisifo esingamahlalakhona. Lokhu kuyiqiniso ikakhulukazi uma unesifo sempilo esanda ingozi yokuba ne-peritonitis ebukhali.

Yini engingayilindela uma nginalesi simo, futhi ingabe lesi sifo singalapheka?

I-acute pericarditis ivame ukuba yisimo esingelapheka futhi esingelapheka . Iningi labantu liyalulama ngemva kokwelashwa. Abantu abaphakathi kuka-20% no-50% bazoba nalesi simo izikhathi ezingaphezu kwesisodwa. Kodwa-ke, ezinye izindlela zokwelapha ezilwa nokuvuvukala zinganciphisa ingozi yokuthi siphinde sivele.

Kuye ngokuthi imbangela ye-acute pericarditis yakho, ungase ube ne -constrictive pericarditis.Kungase kube nengozi eyengeziwe yokuba nenkinga ebizwa ngokuthi i-pericarditis. Lokhu kwenzeka lapho ulwelwesi lwenhliziyo luba lujiyile futhi luncipha ngenxa yezibazi. Lokhu kunganciphisa ikhono lenhliziyo lokupompa. Lokhu kwenzeka ku-20% kuya ku-30% weziguli ezine-acute pericarditis ebangelwa isifo sofuba noma ukutheleleka ngamagciwane. Leli phesenti lehla laya ku-2% kuya ku-5% ezigulini ezine-pericarditis ehlobene nomdlavuza noma izifo zesimiso sokuzivikela komzimba. Kwenzeka ku-1% weziguli ezine-acute pericarditis ebangelwa imbangela engaziwa noma ebangelwa ukutheleleka ngegciwane.

Lesi simo sizohlala isikhathi esingakanani, futhi ngingaqhubeka nini nemisebenzi yami evamile?

I-pericarditis ebukhali engelashwanga ingaholela kwezinye izimo, ezinye zazo ezingaba zimbi kakhulu futhi zibe yingozi. Ngakho-ke, ungashiyi lesi simo singalashwa.

Ngokwelashwa, i-acute pericarditis kufanele ibe ngcono phakathi namasonto ambalwa. Kodwa-ke, abantu abaningi kuzodingeka bayeke ukwenza umsebenzi womzimba - okuhlanganisa ukuzivocavoca kanye nemidlalo - kuze kube yilapho izimpawu zabo zithuthuka. Kuvamile ukuthi izimpawu zibuye uma beqala ukuzivocavoca ngokushesha. Udokotela wakho uzochaza ukuthi yini ongayilindela futhi uzohlela ama-aphoyintimenti okulandelela ukuze aqaphe ukululama kwakho ukuze abone ukuthi kukhona yini izinkinga.

Kufanele ngimbone nini udokotela wami futhi kufanele ngifune nini usizo lwezokwelapha?

Uma uke waba ne-acute pericarditis ngaphambili, qaphela izimpawu zokuphinda ubuye ngesikhathi sokululama kwakho, noma izimpawu zokushintsha noma zokuba zimbi kakhulu. Uma unalezi zimpawu, shayela udokotela wakho, noma ufune usizo lwezokwelapha ngaphandle kwamahora abo ehhovisi.

Izimpawu eziyinhloko okufanele uziqaphele yilezi:

• Ubuhlungu besifuba. *
• Imfiva.
• Ubunzima bokuphefumula (i-Dyspnea).

*> Lesi sibonakaliso singaba uphawu lokuhlaselwa yinhliziyo, ngakho-ke kufanele ushayele u-1990 (noma inombolo yakho yesimo esiphuthumayo yendawo) ngokushesha.

I-Acute Pericarditis yisimo esivame ukubangela ubuhlungu. Nakuba ngokuvamile kungesona isimo esibucayi sodwa, sinezimpawu ezifana nokuhlaselwa yinhliziyo, okuyisimo esiphuthumayo sezokwelapha. Ingahlotshaniswa nezinye izimo, njenge- cardiac tamponade, okuyisimo esiphuthumayo sezokwelapha. Ngenxa yalokhu kufana nokuhlangana, kubalulekile ukuthi lezi zimpawu zihlolwe udokotela. Uma une-acute pericarditis, ivame ukwelashwa, kodwa abanye abantu bangase babe neziqephu ezingaphezu kwesisodwa.

Umlayezo Wokuya Nawe Ekhaya

Kulungile, ngakho-ke sesikhulume kakhulu nge-Acute Pericarditis. Into ebaluleke kakhulu okufanele uyikhumbule ukuthi uma unezinhlungu esifubeni, ikakhulukazi ubuhlungu obuba bubi kakhulu uma ulele phansi futhi bube ngcono uma ugoba phambili, kanye nezimpawu ezifana nokuphelelwa umoya kanye nomkhuhlane, ungakuthathi kalula.

Kungaba ukuhlaselwa yinhliziyo, ngakho funa iseluleko sezokwelapha ngokushesha.

I-pancreatitis ebukhali ivame ukuba yisifo esingelapheki, kodwa ukwelashwa okufanele kubalulekile.

Landela imiyalelo kadokotela ngqo, phumula isikhathi esibekiwe, bese uthatha imithi yakho ngendlela efanele.

Uma uneminye imibuzo mayelana nalokhu, ungangabazi ukukhuluma nodokotela wakho. Hlala uphilile!

I-Pericarditis , I-Acute Pericarditis, Ubuhlungu Besifuba, Isifo Senhliziyo, Ukuphelelwa Ukuphefumula, Umkhuhlane, Ukushaya Kwenhliziyo, I-Cardiac Tamponade, I-Pericardial Efffusion