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Pelliccia A, Drezner JA, Zorzi A, Corrado D. Prevalence and clinical significance of low QRS voltages in healthy individuals, athletes, and patients with cardiomyopathy: implications for sports pre-participation cardiovascular screening. Eur J Prev Cardiol 2024; 31:1106-1114. [PMID: 38243782 DOI: 10.1093/eurjpc/zwae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/22/2023] [Accepted: 01/13/2024] [Indexed: 01/21/2024]
Abstract
Low QRS voltages (LQRSV), defined as a QRS amplitude from peak to nadir < 0.5 mV in all limb leads, are an emerging diagnostic finding on the electrocardiogram (ECG). In healthy individuals and athletes, LQRSV are rare (2.2-4% of elite athletes, 0.5% of recreational athletes, and 0.3% of sedentary individuals). LQRSV athletes commonly show ventricular arrhythmias (VAs) on exercise, and up to 40% of those with LQRSV and VAs have late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR). The prevalence of LQRSV in arrhythmogenic cardiomyopathy ranges from 17-40%, predicts left ventricular (LV) involvement, and is correlated with more extensive LGE replacement on CMR. In hypertrophic cardiomyopathy (HCM), LQRSV ranges from 0.7-11%. LQRSV-HCM patients have more segments with LGE, despite relatively smaller LV mass, suggesting a more advanced clinical stage and a worse prognosis. In dilated cardiomyopathy (DCM), LQRSV range from 6-7%, but may be higher (36%) in certain genetic forms of DCM. On a follow-up, LQRSV are independently associated with incident cardiac events, such as sudden death, sustained ventricular arrhythmia, or appropriate internal cardioverter defibrillator discharge. In cardiac amyloid, LQRSV range from 34-66% and demonstrate a negative prognostic value, with worse clinical outcomes regardless of underlying biologic, genetic, and clinical variables. In conclusion, LQRSV deserve careful consideration for exclusion of arrhythmogenic substrates in healthy individuals, athletes, and patients. While additional research is needed, it is reasonable that LQRSV should trigger clinical investigation to exclude underlying diseases at risk of life-threatening arrhythmias.
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Affiliation(s)
- Antonio Pelliccia
- Department of Medicine, Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197 Rome, Italy
| | - Jonathan A Drezner
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
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2
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Eschenroeder LW, Krieger E. Abdominal bloating in a middle-aged man. Heart 2022; 108:1857-1920. [DOI: 10.1136/heartjnl-2022-321567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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3
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Hoch VC, Abdel-Hamid M, Liu J, Hall AE, Theyyunni N, Fung CM. ED point-of-care ultrasonography is associated with earlier drainage of pericardial effusion: A retrospective cohort study. Am J Emerg Med 2022; 60:156-163. [PMID: 35986978 PMCID: PMC9937040 DOI: 10.1016/j.ajem.2022.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To determine the association between emergency department point-of-care cardiac ultrasonography (POCUS) utilization and time to pericardial effusion drainage during an 8-year period when the emergency ultrasound program was established at our institution. METHODS We performed a single-center retrospective cohort study in patients undergoing pericardiocentesis or other procedure for evacuation of pericardial effusion. Data was collected using both direct queries to the electronic health record database and two-examiner chart review. The primary outcome was time to intervention for pericardial effusion drainage. Multivariable Cox regression, with and without inverse probability weighting for likelihood to receive POCUS, was used to determine the association between POCUS and time to intervention. Secondary outcomes included 28-day mortality. RESULTS 257 patient encounters were included with 137 receiving POCUS and 120 who did not. The proportion of patients receiving POCUS increased from 18.5% to 69.5% during the early to late periods of the study. POCUS was associated with an earlier median time to intervention of 21.6 h (95% CI 17.2, 24.2) compared to 34.6 h (27.0, 50.5) in the No POCUS group. After adjustment for patient demographics, anticoagulation, time of presentation and hemodynamic instability, POCUS was associated with earlier intervention (HR 2.08 [95% CI 1.56, 2.77]). POCUS use was not associated with a difference in 28-day mortality, which was evaluated as a secondary outcome. However, diagnosis of pericardial effusion by the ED physician using any means (POCUS or other imaging) was associated with decreased 28-day mortality (9.7% vs. 26.0%, -16.3% for POCUS [95% CI -29.1, -3.5]). CONCLUSION POCUS was associated with an earlier time to intervention for pericardial effusions after adjustment for multiple confounding factors. Failure to diagnose pericardial effusion in the ED using any diagnostic testing including POCUS, was associated with increased 28-day mortality.
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Affiliation(s)
- Victoria C Hoch
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mostafa Abdel-Hamid
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jia Liu
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ashley E Hall
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nik Theyyunni
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Christopher M Fung
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.
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4
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Wang S, Zhao J, Wang C, Zhang N. Prognosis and role of clinical and imaging features in patients with malignant pericardial effusion: a single-center study in China. BMC Cardiovasc Disord 2021; 21:565. [PMID: 34836509 PMCID: PMC8627071 DOI: 10.1186/s12872-021-02331-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background The diagnosis of malignant pericardial effusion (MPE) is often associated with a poor prognosis, but due to the complexity and unspecific nature of MPE patients' clinical manifestations, imaging often performs an essential role in diagnosis and prognosis. Methods Patients diagnosed with MPE between 2013 and 2018 at one tumor hospital were included and followed up. The data covered the basic clinical features, imaging findings, treatments and prognosis of patients with MPE, and the factors that may have affected the prognosis were explored. Results A total of 216 patients with MPE were included with the median age of 60 years. The most common primary cancer type was lung cancer (73.6%), the most common symptom was dyspnea (62.9%) and the most common abnormal electrocardiogram finding was sinus tachycardia (42.1%). The median survival time of the 216 patients with MPE was 13.7 months. The factors affecting prognosis were echocardiographic fluid signs (HR = 2.37, P = 0.010), electrocardiographic evidence of sinus tachycardia (HR = 1.76, P = 0.006) and echocardiographic evidence of cardiac tamponade (HR = 3.33, P < 0.001). Conclusions MPE has complex clinical manifestations and an unsatisfactory prognosis. Echocardiographic fluid signs, electrocardiographic evidence of sinus tachycardia, and echocardiographic evidence of cardiac tamponade are independent risk factors affecting prognosis.
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Affiliation(s)
- Shucai Wang
- Department of Cardiology, The Fourth Hospital of Hebei Medical University, 12 Health Road, Shijiazhuang, Hebei, 050011, People's Republic of China
| | - Jiazheng Zhao
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, 12 Health Road, Shijiazhuang, Hebei, 050011, People's Republic of China
| | - Chanchan Wang
- Department of Cardiology, The Fourth Hospital of Hebei Medical University, 12 Health Road, Shijiazhuang, Hebei, 050011, People's Republic of China
| | - Ning Zhang
- Department of Cardiology, The Fourth Hospital of Hebei Medical University, 12 Health Road, Shijiazhuang, Hebei, 050011, People's Republic of China.
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5
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Webner C. Electrocardiogram Findings Associated With Malignant Pericardial Effusion and Cardiac Tamponade. AACN Adv Crit Care 2021; 32:227-232. [PMID: 34161964 DOI: 10.4037/aacnacc2021887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Cynthia Webner
- Cynthia Webner is Adjunct Faculty, Acute Care Nurse Practitioner Program, Malone University, Canton, Ohio; and Partner, Key Choice/Cardiovascular Nursing Education Associates, 4998 Searls Dr NW, North Canton, OH 44720
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6
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Hanson MG, Chan B. The role of point-of-care ultrasound in the diagnosis of pericardial effusion: a single academic center retrospective study. Ultrasound J 2021; 13:2. [PMID: 33538920 PMCID: PMC7862446 DOI: 10.1186/s13089-021-00205-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/19/2021] [Indexed: 11/29/2022] Open
Abstract
Background Symptomatic pericardial effusion (PCE) presents with non-specific features and are often missed on the initial physical exam, chest X-ray (CXR), and electrocardiogram (ECG). In extreme cases, misdiagnosis can evolve into decompensated cardiac tamponade, a life-threatening obstructive shock. The purpose of this study is to evaluate the impact of point-of-care ultrasound (POCUS) on the diagnosis and therapeutic intervention of clinically significant PCE. Methods In a retrospective chart review, we looked at all patients between 2002 and 2018 at a major Canadian academic hospital who had a pericardiocentesis for clinically significant PCE. We extracted the rate of presenting complaints, physical exam findings, X-ray findings, ECG findings, time-to-diagnosis, and time-to-pericardiocentesis and how these were impacted by POCUS. Results The most common presenting symptom was dyspnea (64%) and the average systolic blood pressure (SBP) was 120 mmHg. 86% of people presenting had an effusion > 1 cm, and 89% were circumferential on departmental echocardiogram (ECHO) with 64% having evidence of right atrial systolic collapse and 58% with early diastolic right ventricular collapse. The average time-to-diagnosis with POCUS was 5.9 h compared to > 12 h with other imaging including departmental ECHO. Those who had the PCE identified by POCUS had an average time-to-pericardiocentesis of 28.1 h compared to > 48 h with other diagnostic modalities. Conclusion POCUS expedites the diagnosis of symptomatic PCE given its non-specific clinical findings which, in turn, may accelerate the time-to-intervention.
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Affiliation(s)
- Matthew G Hanson
- Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Barry Chan
- Division of General Internal Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada.
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7
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Mango F, Caselli S, Luchetti A, Pelliccia A. Low QRS voltages in Olympic athletes: Prevalence and clinical correlates. Eur J Prev Cardiol 2020; 27:1542-1548. [PMID: 32228059 DOI: 10.1177/2047487320914758] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Recently, novel interest in low QRS voltages was prompted by the observation that low QRS voltages are present in arrhythmogenic cardiomyopathy patients, even before occurrence of symptoms/events. AIM The purpose of this study was to assess prevalence and clinical correlates of low QRS voltages in Olympic athletes, evaluated and followed-up within our cardiovascular screening programme. METHODS Five hundred and sixteen athletes consecutively examined (2010-2011) were included in this study. A low QRS voltage was defined as amplitude of QRS <0.5 mV in limb and/or <1.0 mV in precordial leads. Cardiovascular evaluation included 12-lead and exercise electrocardiogram, echocardiography and, selectively, additional tests to confirm diagnosis. Athletes were followed-up for 5 ± 2 (1-9) years. RESULTS The majority of athletes (493; 96%) showed normal/increased R/S-wave voltages, but 23 (4%) had low QRS voltages. No differences were observed in low QRS voltage athletes compared to normal/increased QRS voltages for QRS duration, QTc and PR intervals, left ventricular cavity size and mass, or gender and sport participated. However, premature ventricular beats, occurred more frequently in low QRS voltages (39% vs 7%; p < 0.001), with patterns suggesting origin from left or right free wall. No diseases or events were registered in low QRS voltage athletes over the follow-up. CONCLUSIONS In Olympic athletes, the prevalence of low QRS voltages was 4%. Athletes with low QRS voltages did not differ from other athletes according to sport participated in or cardiac dimensions. However, more frequently (39% vs 7%) they showed premature ventricular beats, originating from either the left or right free ventricular wall. Therefore, long-term follow-up with serial clinical evaluations is needed in low QRS voltage athletes, in order to definitely clarify the clinical significance.
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Affiliation(s)
| | - Stefano Caselli
- Institute of Sport Medicine and Science, Italy.,Cardiovascular Center Zurich, Switzerland
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8
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Scarpa D, Famoso G, Zorzi A. Electrical swimming. Emerg Med J 2019; 36:280-286. [PMID: 31015215 DOI: 10.1136/emermed-2018-207750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Daniele Scarpa
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Giulia Famoso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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9
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Montañez-Valverde RA, Olarte NI, Zablah G, Hurtado-de-Mendoza D, Colombo R. Swinging heart caused by diffuse large B-cell lymphoma. Oxf Med Case Reports 2018; 2018:omy075. [PMID: 30159160 PMCID: PMC6109201 DOI: 10.1093/omcr/omy075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/13/2018] [Accepted: 07/20/2018] [Indexed: 01/01/2023] Open
Abstract
Pericardial disease is a common complication of solid tumors and occasionally seen in hematologic malignancies. Pericardial effusion, when it occurs, is usually caused by tumor seeding of the pericardium leading to a serous effusion or by mass effect from mediastinal lymphadenopathy blocking drainage of lymphatic ducts. Pericardial disease from non-Hodgkin's lymphoma is uncommon and malignant pericardial effusion is even rarer. Here we present a case of a 31-year-old male with diffuse large B-cell lymphoma who developed cardiac tamponade from a malignant pericardial effusion.
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Affiliation(s)
- Raúl A Montañez-Valverde
- Beth Israel Deaconess Medical Center/Harvard Medical School, Cardiovascular Division, Boston, MA, USA.,Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Neal Ivan Olarte
- University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - Gerardo Zablah
- University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | | | - Rosario Colombo
- Jackson Memorial Hospital, Cardiovascular Division, Miami, FL, USA
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10
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11
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Verlaan D, Veltman JD, Grady B. Total electrical alternans in a patient with malignant pericardial tamponade. BMJ Case Rep 2018; 2018:bcr-2018-224771. [PMID: 30030246 DOI: 10.1136/bcr-2018-224771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of a 59-year-old man with acute abdominal pain and progressive shortness of breath. A focused assessment with sonography for trauma scan showed free fluid in the hepatorenal recess and in the recto-uterine recess. Later, due to clinical deterioration and the differential possibility of a pulmonary embolism or aortic dissection, a CT scan was performed which revealed large pericardial effusion. This, together with a dilated vena cava inferior and portal system, raised the suspicion of cardiac tamponade. The diagnosis was confirmed by transthoracic echocardiography (TTE). In retrospect, the ECG at admission showed a sinus tachycardia, low-voltage QRS complexes and a total electrical alternans corresponding with the swinging heart seen on TTE. An electrical alternans on ECG is an important diagnostic clue but is often missed, causing an unnecessary delay to proper diagnostic and therapeutic measures.
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Affiliation(s)
- Diede Verlaan
- Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Joris D Veltman
- Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Bart Grady
- Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.,Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Abstract
Cardiogenic shock (CS) is a physiologic state in which cardiac pump function is inadequate to perfuse the tissues. If CS is not rapidly recognized and treated, tissue hypoperfusion can quickly lead to organ dysfunction and patient death. Evaluation of patients with suspected CS should include an electrocardiogram, chest radiograph, laboratory studies, and bedside echocardiogram. Initial resuscitation is directed toward restoring cardiac output and tissue perfusion. Mechanical circulatory support is indicated for patients with CS who do not respond to pharmacologic therapy. Ultimately, these patients should undergo emergent reperfusion therapy with either percutaneous coronary intervention or coronary artery bypass grafting.
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Affiliation(s)
- Semhar Z Tewelde
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA
| | - Stanley S Liu
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, 110 South Paca Street 7-N-127, Baltimore, MD 21224, USA
| | - Michael E Winters
- Emergency Medicine/Internal Medicine/Critical Care Program, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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13
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Li SS, Rossfeld Z, Basu SK. Cardiac Tamponade in a Child With Fever of Unknown Origin. Hosp Pediatr 2017; 7:692-696. [PMID: 29089379 DOI: 10.1542/hpeds.2017-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Susan S Li
- Department of Pediatrics and
- Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Zachary Rossfeld
- Department of Pediatrics and
- Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Sanmit K Basu
- Department of Pediatrics and
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio; and
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14
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Stolz L, Valenzuela J, Situ-LaCasse E, Stolz U, Hawbaker N, Thompson M, Adhikari S. Clinical and historical features of emergency department patients with pericardial effusions. World J Emerg Med 2017; 8:29-33. [PMID: 28123617 DOI: 10.5847/wjem.j.1920-8642.2017.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Diagnosing pericardial effusion is critical for optimal patient care. Typically, clinicians use physical examination findings and historical features suggesting pericardial effusion to determine which patients require echocardiography. The diagnostic characteristics of these tools are not well described. The objective of this study is to determine the prevalence of historical features and sensitivity of clinical signs to inform clinicians when to proceed with echocardiogram. METHODS A retrospective review of point-of-care echocardiograms performed over a two and a half year period in two emergency departments were reviewed for the presence of a pericardial effusion. Patient charts were reviewed and abstracted for presenting symptoms, historical features and clinical findings. The prevalence of presenting symptoms and historical features and the sensitivity of classic physical examination findings associated with pericardial effusion and tamponade were determined. RESULTS One hundred and fifty-three patients with pericardial effusion were identified. Of these patients, the most common presenting complaint was chest pain and shortness of breath. Patients had no historical features that would suggest pericardial effusion in 37.5% of cases. None of the patients with pericardial effusion or pericardial tamponade had all of the elements of Beck's triad. The sensitivity of Beck's triad was found to be 0 (0%-19.4%). The sensitivity for one finding of Beck's triad to diagnose pericardial tamponade was 50% (28.0%-72.0%). CONCLUSION History and physical examination findings perform poorly as tests for the diagnosis of pericardial effusion or pericardial tamponade. Clinicians must liberally evaluate patients suspected of having a pericardial effusion with echocardiography.
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Affiliation(s)
- Lori Stolz
- Department of Emergency Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Josephine Valenzuela
- Department of Emergency Medicine, University of California, San Francisco, CA 94143-0410, USA
| | - Elaine Situ-LaCasse
- Department of Emergency Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Uwe Stolz
- Department of Emergency Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Nicolas Hawbaker
- Department of Emergency Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Matthew Thompson
- Department of Emergency Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Srikar Adhikari
- Department of Emergency Medicine, University of Arizona, Tucson, AZ 85721, USA
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15
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McCanny P, Colreavy F. Echocardiographic approach to cardiac tamponade in critically ill patients. J Crit Care 2016; 39:271-277. [PMID: 28087158 DOI: 10.1016/j.jcrc.2016.12.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 12/26/2022]
Abstract
Cardiac tamponade should be considered in a critically ill patient in whom the cause of haemodynamic shock is unclear. When considering tamponade, transthoracic echocardiography plays an essential role and is the initial investigation of choice. Diagnostic sensitivity of transthoracic echocardiography is dependent on image quality, and in some cases a transoesophageal approach may be required to confirm the diagnosis. Knowledge of the pathophysiology and echocardiographic features of cardiac tamponade are essential for the practicing Intensivist. This review presents an approach to the recognition, diagnosis, and treatment of cardiac tamponade in critically ill patients.
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Affiliation(s)
- Peter McCanny
- Department of Critical Care Medicine, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - Frances Colreavy
- Department of Critical Care Medicine, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland; University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
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16
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Yusuf SW, Hassan SA, Mouhayar E, Negi SI, Banchs J, O'Gara PT. Pericardial disease: a clinical review. Expert Rev Cardiovasc Ther 2016; 14:525-39. [PMID: 26691443 DOI: 10.1586/14779072.2016.1134317] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Pericardial disease is infrequently encountered in cardiovascular practice, but can lead to significant morbidity and mortality. Clinical data and practice guidelines are relatively sparse. Early recognition and prompt treatment of pericardial diseases are critical to optimize patient outcomes. In this review we provide a concise summary of acute pericarditis, constrictive pericarditis and pericardial effusion/tamponade.
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Affiliation(s)
- Syed Wamique Yusuf
- a Department of Cardiology , University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Saamir A Hassan
- a Department of Cardiology , University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Elie Mouhayar
- a Department of Cardiology , University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Smita I Negi
- a Department of Cardiology , University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Jose Banchs
- a Department of Cardiology , University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Patrick T O'Gara
- b Cardiovascular Medicine Division, Department of Medicine, Harvard Medical School , Brigham and Women's Hospital , Boston , MA , USA
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17
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Yusuf SW, Negi SI, Banchs J, Argula RG. Authors' Reply. Clin Cardiol 2015. [PMID: 26216008 DOI: 10.1002/clc.22415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Syed Wamique Yusuf
- MD Anderson Cancer Center, Department of Cardiology, University of Texas, Houston, Texas
| | - Smita I Negi
- MD Anderson Cancer Center, Department of Cardiology, University of Texas, Houston, Texas
| | - Jose Banchs
- MD Anderson Cancer Center, Department of Cardiology, University of Texas, Houston, Texas
| | - Rahul G Argula
- MD Anderson Cancer Center, Department of Cardiology, University of Texas, Houston, Texas.,Division of Pulmonary Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina
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Khalid N, Chhabra L, Spodick DH. Response to Role of a 12-Lead Electrocardiogram in the Diagnosis of Cardiac Tamponade as Diagnosed by Transthoracic Echocardiography in Patients With Malignant Pericardial Effusion. Clin Cardiol 2015. [DOI: 10.1002/clc.22416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Nauman Khalid
- Department of Cardiovascular Medicine, Hartford Hospital; University of Connecticut Health Center; Hartford Connecticut
| | - Lovely Chhabra
- Hartford Hospital; University of Connecticut School of Medicine; Hartford Connecticut
| | - David H. Spodick
- Saint Vincent Hospital; University of Massachusetts Medical School; Worcester Massachusetts
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