Medical Fact of the Day – Heart Swinging
Today's fact comes from a case presented in the New England Journal of Medicine. The 39-year-old woman was being treated for melanoma, a skin cancer, but the disease showed steady spreading. Among other symptoms, her heart rate was 110 and blood pressure 82/64 mmHg (normally 60-70 and 120/80, respectively). This suggested some sort of heart defect, and an echocardiogram was taken to image the heart in action.
This picture, taken from this video, shows the heart swinging within the chest as it beats. Needless to say, this is not normal - the heart usually sits still within its cavity, happily pumping away.
This heart has gone wild. Arrows point to portions of the heart that have collapsed (not a good thing). From Kapoor JR, McConnell MV. NEJM 2009 Oct 29; 361(18):e37.
This happens because the chamber within which the heart usually sits - the pericardium - has filled with fluid when it should be snug against the heart. In this case, the space has filled with fluid because the metastatic cancer spread to the pericardium. The heart now has space to swing about as it beats.
When the pericardium fills with enough fluid, it increases pressure against the heart and can disrupt its normal function, leading to cardiac tamponade. In the picture above, you can see that chambers of the heart collapse after beating, a sign of too much pressure against the walls of the heart.
They eventually sucked out 1.6 liters of fluid, about 160x the amount of fluid usually in the space (10 mL).
Other reasons that pericardial effusion can occur include infection (with viruses, bacteria, or parasites) and inflammatory disorders.
Click here for a video of the swinging heart in action. It's well worth the time.
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October 30th, 2009 - 01:26
Amazing video. Does this have anything to do with teenagers who suddenly die from a heart attack? I’ve seen this reported twice in my area.
October 31st, 2009 - 15:24
That’s insane. So what’s that fluid usually good for?
October 31st, 2009 - 21:30
Dahar: Actually we learned about that recently – with younger adults it usually has to do with hypertrophic cardiomyopathy. This is a genetic condition that causes the heart muscle to thicken abnormally and pathologically. This leads to problems with normal heart function, and often with sufficient stress (like a huge workout) sudden death can occur. You can read more about it here: http://en.wikipedia.org/wiki/Hypertrophic_cardiomyopathy
October 31st, 2009 - 21:32
mike: The fluid is usually a lubricant that lets the heart slide against the pericardium with less friction. The heart usually does move as it contracts, just not to the extreme degree you see here.
November 1st, 2009 - 00:03
whoa, thats crazy. So was she able to live for an extended amount of time with her heart bouncing everywhere? Or did she get hospitalized and treated as soon it started?
November 1st, 2009 - 08:44
Andy: Actually this had been going on for a while, and they just happened to catch it on a checkup. They removed the fluid, and over the next two days there was no reaccumulation of fluid. They then started her on another chemo treatment but she died within two months (Stage IV cancer = metastatic, spreads all over body).
November 1st, 2009 - 10:29
How did the metastatic cancer cause the fluid to fill up the percardium?
November 1st, 2009 - 18:12
Joey: Good question. Most likely the tumor blocks lymph nodes in the chest that drain the pericardium, leading to excess fluid building up.
November 1st, 2009 - 23:49
That’s crazy… what would have happened to her without the checkup?
November 6th, 2009 - 21:24
Anne: Her heart’s been going like that for a while, so it would take some more time to show some clear symptoms. Most likely she would suffer from heart failure, general inability to supply the tissues with oxygenated blood, hypotension, trouble breathing, you name it.