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Adler Y, Ristić AD, Imazio M, Brucato A, Pankuweit S, Burazor I, Seferović PM, Oh JK. Cardiac tamponade. Nat Rev Dis Primers 2023; 9:36. [PMID: 37474539 DOI: 10.1038/s41572-023-00446-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/22/2023]
Abstract
Cardiac tamponade is a medical emergency caused by the progressive accumulation of pericardial fluid (effusion), blood, pus or air in the pericardium, compressing the heart chambers and leading to haemodynamic compromise, circulatory shock, cardiac arrest and death. Pericardial diseases of any aetiology as well as complications of interventional and surgical procedures or chest trauma can cause cardiac tamponade. Tamponade can be precipitated in patients with pericardial effusion by dehydration or exposure to certain medications, particularly vasodilators or intravenous diuretics. Key clinical findings in patients with cardiac tamponade are hypotension, increased jugular venous pressure and distant heart sounds (Beck triad). Dyspnoea can progress to orthopnoea (with no rales on lung auscultation) accompanied by weakness, fatigue, tachycardia and oliguria. In tamponade caused by acute pericarditis, the patient can experience fever and typical chest pain increasing on inspiration and radiating to the trapezius ridge. Generally, cardiac tamponade is a clinical diagnosis that can be confirmed using various imaging modalities, principally echocardiography. Cardiac tamponade is preferably resolved by echocardiography-guided pericardiocentesis. In patients who have recently undergone cardiac surgery and in those with neoplastic infiltration, effusive-constrictive pericarditis, or loculated effusions, fluoroscopic guidance can increase the feasibility and safety of the procedure. Surgical management is indicated in patients with aortic dissection, chest trauma, bleeding or purulent infection that cannot be controlled percutaneously. After pericardiocentesis or pericardiotomy, NSAIDs and colchicine can be considered to prevent recurrence and effusive-constrictive pericarditis.
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Affiliation(s)
- Yehuda Adler
- Sackler Faculty of Medicine, Tel Aviv University, Bnei Brak, Israel.
- College of Law and Business, Ramat Gan, Israel.
| | - Arsen D Ristić
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
| | - Massimo Imazio
- Cardiothoracic Department, Cardiology, University Hospital Santa Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, The University of Milan, Milan, Italy
| | - Sabine Pankuweit
- Department of Internal Medicine-Cardiology, Philipps University Marburg, Marburg, Germany
| | - Ivana Burazor
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Institute for Cardiovascular Diseases "Dedinje" and Belgrade University, Faculty of Medicine, Belgrade, Serbia
| | - Petar M Seferović
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Ostad Karampour S, Sedlak TL, Luong CL, Price JE, Brunner NW. A case report of pericardial constriction with coexisting severe left main coronary artery disease. Eur Heart J Case Rep 2022; 6:ytac272. [PMID: 35854891 PMCID: PMC9290554 DOI: 10.1093/ehjcr/ytac272] [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: 10/27/2021] [Revised: 01/21/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Constrictive pericarditis (CP) is a rare condition in which the pericardium becomes progressively fibrotic and non-compliant leading to impaired ventricular filling and overt heart failure. While CP shares many clinical and haemodynamic similarities with restrictive cardiomyopathy, differentiation of these diseases is crucial as CP is potentially curative through pericardiectomy. Here, we present a case of proven pericardial constriction with atypical haemodynamics in a patient presenting with heart failure and severe left main coronary artery disease (CAD). CASE SUMMARY A 69-year-old female with a history of hypertension and paroxysmal atrial fibrillation presented with persistent heart failure refractory to diuretics. Ischaemic and infiltrative work-up were found to be negative with magnetic resonance imaging demonstrating trace pericardial fluid and thickening of the pericardium. Echocardiogram and right-heart catheterization demonstrated atypical haemodynamics suggestive of but not conclusive for CP, with coronary angiogram demonstrating severe left main CAD. Ultimately, the patient underwent coronary artery bypass grafting along with pericardiectomy and pericardial biopsy demonstrating constrictive physiology. DISCUSSION We suspect the inconclusive nature of the echocardiogram and cardiac catheterization was likely secondary to severe CAD impairing left ventricular relaxation and dampening ventricular interdependence. As such, clinicians should consider the possibility of coexistent severe CAD in patients with a clinical suspicion of CP, but inconclusive haemodynamics.
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Affiliation(s)
- Saman Ostad Karampour
- Division of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9
| | - Tara L Sedlak
- Division of Cardiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9
| | - Christina L Luong
- Division of Cardiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9
| | - Joel E Price
- Division of Cardiac Surgery, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9
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Egorova AD, Schalij MJ, Kiès P. The constrictive consequences of pericardial calcifications. Clin Case Rep 2020; 8:2320-2321. [PMID: 33235793 PMCID: PMC7669375 DOI: 10.1002/ccr3.3116] [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: 04/17/2020] [Revised: 05/14/2020] [Accepted: 06/13/2020] [Indexed: 11/09/2022] Open
Abstract
A 53-year-old man presented with symptomatic severe pulmonary valve regurgitation. He underwent a diagnostic catheterization. A heavily calcified pericardium and the pressure tracings illustrate typical features of constrictive pericarditis physiology, including the "square root sign." This condition is important to recognize given the progressive nature and poor prognosis if untreated.
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Affiliation(s)
- Anastasia D. Egorova
- Department of CardiologyHeart Lung CenterLeiden University Medical CenterLeidenThe Netherlands
| | - Martin J. Schalij
- Department of CardiologyHeart Lung CenterLeiden University Medical CenterLeidenThe Netherlands
| | - Philippine Kiès
- Department of CardiologyHeart Lung CenterLeiden University Medical CenterLeidenThe Netherlands
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4
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Farooqui F. Constrictive pericarditis. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2019. [DOI: 10.4103/jpcs.jpcs_45_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Although incidence is rare, acute cardiac tamponade (CT) is a cardiovascular condition often resulting in a high mortality rate. In acute CT, rapid accumulation of fluid occurs in the pericardial sac and prevents the heart's chambers from adequately filling with blood, leading to reduced diastolic filling, diminished stroke volumes, and subsequent hemodynamic instability. Health care providers should be aware of at-risk patients and the earliest signs and symptoms because an acute CT is considered a medical emergency.
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Restrictive Cardiomyopathies: The Importance of Noninvasive Cardiac Imaging Modalities in Diagnosis and Treatment-A Systematic Review. Radiol Res Pract 2017; 2017:2874902. [PMID: 29270320 PMCID: PMC5705874 DOI: 10.1155/2017/2874902] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/02/2017] [Indexed: 12/19/2022] Open
Abstract
Restrictive cardiomyopathy (RCM) is the least common among cardiomyopathies. It can be idiopathic, familial, or secondary to systematic disorders. Marked increase in left and/or right ventricular filling pressures causes symptoms and signs of congestive heart failure. Electrocardiographic findings are nonspecific and include atrioventricular conduction and QRS complex abnormalities and supraventricular and ventricular arrhythmias. Echocardiography and cardiac magnetic resonance (CMR) play a major role in diagnosis. Echocardiography reveals normal or hypertrophied ventricles, preserved systolic function, marked biatrial enlargement, and impaired diastolic function, often with restrictive filling pattern. CMR offering a higher spatial resolution than echocardiography can provide detailed information about anatomic structures, perfusion, ventricular function, and tissue characterization. CMR with late gadolinium enhancement (LGE) and novel approaches (myocardial mapping) can direct the diagnosis to specific subtypes of RCM, depending on the pattern of scar formation. When noninvasive studies have failed, endomyocardial biopsy is required. Differentiation between RCM and constrictive pericarditis (CP), nowadays by echocardiography, is important since both present as heart failure with normal-sized ventricles and preserved ejection fraction but CP can be treated by means of anti-inflammatory and surgical treatment, while the treatment options of RCM are dictated by the underlying condition. Prognosis is generally poor despite optimal medical treatment.
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Garcia JR, Campbell PF, Kumar G, Langberg JJ, Cesar L, Wang L, García AJ, Levit RD. A Minimally Invasive, Translational Method to Deliver Hydrogels to the Heart Through the Pericardial Space. JACC Basic Transl Sci 2017; 2:601-609. [PMID: 30062173 PMCID: PMC6058920 DOI: 10.1016/j.jacbts.2017.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/21/2017] [Accepted: 06/01/2017] [Indexed: 12/11/2022]
Abstract
Biomaterials are a new treatment strategy for cardiovascular diseases but are difficult to deliver to the heart in a safe, precise, and translatable way. We developed a method to deliver hydrogels to the epicardium through the pericardial space. Our device creates a temporary compartment for hydrogel delivery and gelation using anatomic structures. The method minimizes risk to patients from embolization, thrombotic occlusion, and arrhythmia. In pigs there were no clinically relevant acute or subacute adverse effects from pericardial hydrogel delivery, making this a translatable strategy to deliver biomaterials to the heart.
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Affiliation(s)
- Jose R. Garcia
- Woodruff School of Mechanical Engineering, Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia
| | | | - Gautam Kumar
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Division of Cardiology, Atlanta VA Medical Center, Atlanta, Georgia
| | - Jonathan J. Langberg
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Liliana Cesar
- T3 Labs-Translational, Testing and Training Laboratories, Inc., Atlanta, Georgia
| | - Lanfang Wang
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Andrés J. García
- Woodruff School of Mechanical Engineering, Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia
| | - Rebecca D. Levit
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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Sayegh ALC, Dos Santos MR, Sarmento AO, de Souza FR, Salemi VMC, Hotta VT, Marques ACDB, Krämer HH, Trombetta IC, Mady C, Alves MJDNN. Cardiac and peripheral autonomic control in restrictive cardiomyopathy. ESC Heart Fail 2017; 4:341-350. [PMID: 28772037 PMCID: PMC5542737 DOI: 10.1002/ehf2.12142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/19/2017] [Accepted: 02/03/2017] [Indexed: 12/18/2022] Open
Abstract
AIMS Autonomic dysfunction determines the advance of dilated cardiomyopathy (DCM) and is related to poor outcomes. However, this autonomic imbalance is unknown in patients with restrictive cardiomyopathy (RCM) even though they have similar symptoms and poor quality of life as DCM patients have. The aim of this study was to evaluate if autonomic and neurovascular controls were altered in RCM patients. METHODS AND RESULTS Fifteen RCM patients, 10 DCM patients, and 10 healthy subjects were evaluated. Heart rate and blood pressure (BP) were recorded. Peripheral sympathetic activity [muscle sympathetic nerve activity (MSNA)] by microneurography and cardiac sympathetic activity by power spectrum analysis of heart rate variability. Spontaneous baroreflex sensitivity (BRS) was evaluated by the sequence method and forearm blood flow by venous occlusion plethysmography. Both cardiomyopathy groups had higher MSNA frequency (P < 0.001) and MSNA incidence (P < 0.001), higher cardiac sympathovagal balance (P < 0.02), reduced BRS for increase (P = 0.002) and for decrease in BP (P = 0.002), and lower forearm blood flow (P < 0.001) compared with healthy subjects. We found an inverse correlation between BRS for increase and decrease in BP and peripheral sympathetic activity (r = -0.609, P = 0.001 and r = -0.648, P < 0.001, respectively) and between BRS for increase and decrease in BP and cardiac sympathetic activity (r = -0.503, P = 0.03 and r = -0.487, P = 0.04, respectively). CONCLUSIONS The RCM patients had cardiac and peripheral autonomic dysfunctions associated with peripheral vasoconstriction. Nonetheless, the presence of normal ejection fraction underestimates the evolution of the disease and makes clinical treatment difficult. These alterations could lead to a similar cardiovascular risk as that observed in DCM patients.
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Affiliation(s)
- Ana Luiza C Sayegh
- Clinical Unit of Cardiomyopathy, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Marcelo R Dos Santos
- Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Adriana O Sarmento
- Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Francis R de Souza
- Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Vera M C Salemi
- Clinical Unit of Heart Failure, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Viviane T Hotta
- Clinical Unit of Cardiomyopathy, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Akothirene Cristhina D B Marques
- Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Heidrum H Krämer
- Departmente of Neurology, Justus-Liebig-University, Giessen, Germany
| | - Ivani C Trombetta
- Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Charles Mady
- Clinical Unit of Cardiomyopathy, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
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Murillo H, Restrepo CS, Marmol-Velez JA, Vargas D, Ocazionez D, Martinez-Jimenez S, Reddick RL, Baxi AJ. Infectious Diseases of the Heart: Pathophysiology, Clinical and Imaging Overview. Radiographics 2017; 36:963-83. [PMID: 27399236 DOI: 10.1148/rg.2016150225] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Myriad infectious organisms can infect the endocardium, myocardium, and pericardium, including bacteria, fungi, parasites, and viruses. Significant cardiac infections are rare in the general population but are associated with high morbidity and mortality as well as increased risk in certain populations, such as the elderly, those undergoing cardiac instrumentation, and intravenous drug abusers. Diagnostic imaging of cardiac infections plays an important role despite its variable sensitivity and specificity, which are due in part to the nonspecific manifestations of the central inflammatory process of infection and the time of onset with respect to the time of imaging. The primary imaging modality remains echocardiography. However, cardiac computed tomography and magnetic resonance (MR) imaging have emerged as the modalities of choice wherever available, especially for diagnosis of complex infectious complications including abscesses, infected prosthetic material, central lines and instruments, and the cryptic manifestations of viral and parasitic diseases. MR imaging can provide functional, morphologic, and prognostic value in a single examination by allowing characterization of inflammatory changes from the acute to chronic stages, including edema and the patterns and extent of delayed gadolinium enhancement. We review the heterogeneous and diverse group of cardiac infections based on their site of primary cardiac involvement with emphasis on their cross-sectional imaging manifestations. Online supplemental material is available for this article. (©)RSNA, 2016.
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Affiliation(s)
- Horacio Murillo
- From the Division of Medical Imaging, Sutter Medical Group, 1500 Expo Pkwy, Sacramento, CA 95815 (H.M.); Department of Radiology (C.S.R., A.J.B.), Division of Cardiology (J.A.M.), and Department of Pathology (R.L.R.), University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Radiology, University of Colorado Anschutz Medical Center, Aurora, Colo (D.V.); Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, Saint Luke's Health System, Kansas City, Mo (S.M.)
| | - Carlos Santiago Restrepo
- From the Division of Medical Imaging, Sutter Medical Group, 1500 Expo Pkwy, Sacramento, CA 95815 (H.M.); Department of Radiology (C.S.R., A.J.B.), Division of Cardiology (J.A.M.), and Department of Pathology (R.L.R.), University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Radiology, University of Colorado Anschutz Medical Center, Aurora, Colo (D.V.); Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, Saint Luke's Health System, Kansas City, Mo (S.M.)
| | - Juan Alejandro Marmol-Velez
- From the Division of Medical Imaging, Sutter Medical Group, 1500 Expo Pkwy, Sacramento, CA 95815 (H.M.); Department of Radiology (C.S.R., A.J.B.), Division of Cardiology (J.A.M.), and Department of Pathology (R.L.R.), University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Radiology, University of Colorado Anschutz Medical Center, Aurora, Colo (D.V.); Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, Saint Luke's Health System, Kansas City, Mo (S.M.)
| | - Daniel Vargas
- From the Division of Medical Imaging, Sutter Medical Group, 1500 Expo Pkwy, Sacramento, CA 95815 (H.M.); Department of Radiology (C.S.R., A.J.B.), Division of Cardiology (J.A.M.), and Department of Pathology (R.L.R.), University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Radiology, University of Colorado Anschutz Medical Center, Aurora, Colo (D.V.); Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, Saint Luke's Health System, Kansas City, Mo (S.M.)
| | - Daniel Ocazionez
- From the Division of Medical Imaging, Sutter Medical Group, 1500 Expo Pkwy, Sacramento, CA 95815 (H.M.); Department of Radiology (C.S.R., A.J.B.), Division of Cardiology (J.A.M.), and Department of Pathology (R.L.R.), University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Radiology, University of Colorado Anschutz Medical Center, Aurora, Colo (D.V.); Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, Saint Luke's Health System, Kansas City, Mo (S.M.)
| | - Santiago Martinez-Jimenez
- From the Division of Medical Imaging, Sutter Medical Group, 1500 Expo Pkwy, Sacramento, CA 95815 (H.M.); Department of Radiology (C.S.R., A.J.B.), Division of Cardiology (J.A.M.), and Department of Pathology (R.L.R.), University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Radiology, University of Colorado Anschutz Medical Center, Aurora, Colo (D.V.); Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, Saint Luke's Health System, Kansas City, Mo (S.M.)
| | - Robert Lee Reddick
- From the Division of Medical Imaging, Sutter Medical Group, 1500 Expo Pkwy, Sacramento, CA 95815 (H.M.); Department of Radiology (C.S.R., A.J.B.), Division of Cardiology (J.A.M.), and Department of Pathology (R.L.R.), University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Radiology, University of Colorado Anschutz Medical Center, Aurora, Colo (D.V.); Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, Saint Luke's Health System, Kansas City, Mo (S.M.)
| | - Ameya Jagdish Baxi
- From the Division of Medical Imaging, Sutter Medical Group, 1500 Expo Pkwy, Sacramento, CA 95815 (H.M.); Department of Radiology (C.S.R., A.J.B.), Division of Cardiology (J.A.M.), and Department of Pathology (R.L.R.), University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Radiology, University of Colorado Anschutz Medical Center, Aurora, Colo (D.V.); Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, Saint Luke's Health System, Kansas City, Mo (S.M.)
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Geske JB, Anavekar NS, Nishimura RA, Oh JK, Gersh BJ. Differentiation of Constriction and Restriction. J Am Coll Cardiol 2016; 68:2329-2347. [DOI: 10.1016/j.jacc.2016.08.050] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/04/2016] [Accepted: 08/09/2016] [Indexed: 12/25/2022]
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Doshi S, Ramakrishnan S, Gupta SK. Invasive hemodynamics of constrictive pericarditis. Indian Heart J 2015; 67:175-82. [PMID: 26071303 PMCID: PMC4475854 DOI: 10.1016/j.ihj.2015.04.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 04/13/2015] [Indexed: 01/10/2023] Open
Abstract
Cardiac catheterization and hemodynamic study is the gold standard for the diagnosis of pericardial constriction. Careful interpretation of the hemodynamic data is essential to differentiate it from other diseases with restrictive physiology. In this hemodynamic review we shall briefly discuss the physiologic basis of various hemodynamic changes seen in a patient with constrictive pericarditis.
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Affiliation(s)
- Shrenik Doshi
- All India Institute of Medical Sciences, New Delhi, India
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Murphy LA, Russell NJ, Dulake MI, Nakamura RK. Constrictive pericarditis following surgical repair of a peritoneopericardial diaphragmatic hernia in a cat. J Feline Med Surg 2014; 16:708-12. [PMID: 24789591 PMCID: PMC11164158 DOI: 10.1177/1098612x13517113] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 4-year-old female spayed domestic longhair cat was referred for dyspnea. Further diagnostics revealed severe pleural effusion and a peritoneopericardial diaphragmatic hernia (PPDH). Following surgical correction of the PPDH the pleural effusion persisted. Re-check echocardiogram 4 weeks after initial evaluation revealed leftward deviation of the interventricular septum and interatrial septum occurring with inspiration. There were also exaggerated phasic changes in trans-tricuspid flow velocities suggestive of constrictive pericardial disease. Cardiac catheterization was performed and revealed elevated pressures in the right atrium and right ventricle. Constrictive pericarditis (CP) and epicarditis was confirmed at surgery, where subtotal pericardiectomy was performed with epicardial decortication. The cat continued to develop recurrent pleural effusion after surgery, although the volume and frequency of recurrence slowed over time. This is the first reported case of CP following PPDH repair in a cat.
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Affiliation(s)
| | | | | | - Reid K Nakamura
- Veterinary Medical Surgical Group - Orange County, San Juan Capistrano, CA, USA
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Buitrago AF, Gómez M, Restrepo JA, Soto M, Díaz JH. Diagnóstico hemodinámico de pericarditis constrictiva: presentación de un caso y revisión de la literatura. REVISTA COLOMBIANA DE CARDIOLOGÍA 2013. [DOI: 10.1016/s0120-5633(13)70092-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Schroeder JR, Osorno H, Chait R, Fischer A. Hiding in plain sight; constrictive pericarditis. BMJ Case Rep 2013; 2013:bcr-2013-008788. [PMID: 23446050 DOI: 10.1136/bcr-2013-008788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a case of constrictive pericarditis that was especially difficult to diagnose. The patient presented with generalised oedema, dyspnoea and pleural effusions. History was significant for prior polysubstance abuse but was otherwise unremarkable. Physical examination revealed only jugular venous distention. CT demonstrated a normal pericardium with pleural effusions. Echocardiography showed mildly elevated right ventricular pressures with dyssynergic motion of the ventricular septum. No intervention was being carried out, but 1 month later further evaluation with a right and left heart catheterisation showed the classical square-root sign with equalisation of diastolic pressures in both ventricles as well as ventricular interdependence. Idiopathic constrictive pericarditis was thus diagnosed with a subsequent pericardial stripping which confirmed a thickened pericardium encasing the heart.
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Affiliation(s)
- Jonathan Ryan Schroeder
- Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, West Palm Beach, Florida, USA.
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Pinamonti B, Finocchiaro G, Moretti M, Merlo M, Sinagra G. Diastolic dysfunction in cardiomyopathies. J Cardiovasc Echogr 2011. [DOI: 10.1016/j.jcecho.2011.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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