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Sarode K, Patel A, Arrington K, Makhija R, Mukherjee D. Pericardial Decompression Syndrome: A Comprehensive Review of a Controversial Entity. Int J Angiol 2024; 33:139-147. [PMID: 39131808 PMCID: PMC11315602 DOI: 10.1055/s-0044-1780536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024] Open
Abstract
Pericardial decompression syndrome is an ambiguous clinical entity which has generated controversy regarding its existence. Following pericardial decompression, patients experienced clinical deterioration ranging in complications from pulmonary edema to death that could not be attributed to any other distinct clinical pathology. Multiple theories have suggested the pathophysiology behind pericardial decompression syndrome is related to preload-afterload mismatch following pericardial decompression, coronary microvascular ischemia, and stress from high adrenergic state. Our review aims to describe this syndrome by analyzing demographics, etiology of pericardial effusion, method of drainage, volume of pericardial fluid removed, time to decompensation, and clinical outcomes. A systematic review of MEDLINE/PubMed and Google Scholar literature databases were queried for case reports, case series, review articles, and abstracts published in English journals between 1983 and December 2022. Each author's interpretation of echocardiographic and/or pulmonary arterial catheterization data provided in the case reports was used to characterize ventricular dysfunction. Based on our inclusion criteria, 72 cases of pericardial decompression syndrome were included in our review. Our results showed that phenotypic heterogeneity was present based on echocardiographic findings of right/left or biventricular failure with similar proportions in each type of ventricular dysfunction. Time to decompensation was similar between immediate, subacute, and acute cases with presentation varying between hypoxic respiratory failure and shock. This review article highlights theories behind the pathophysiology, clinical outcomes, and therapeutic options in this high mortality condition.
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Affiliation(s)
- Karan Sarode
- Department of Cardiovascular Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Amar Patel
- Department of Cardiovascular Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Kedzie Arrington
- Department of Cardiovascular Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Rakhee Makhija
- Department of Cardiovascular Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Debabrata Mukherjee
- Department of Cardiovascular Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
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Sobieski C, Herner M, Goyal N, Khor LL, Chang L, Bieging E, McGarry TJ. Pericardial Decompression Syndrome After Drainage of Chronic Pericardial Effusions. JACC Case Rep 2022; 4:1515-1521. [PMID: 36444176 PMCID: PMC9700074 DOI: 10.1016/j.jaccas.2022.08.023] [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: 05/16/2022] [Revised: 07/20/2022] [Accepted: 08/10/2022] [Indexed: 06/16/2023]
Abstract
Pericardial decompression syndrome (PDS) is a potentially fatal disorder of left ventricular function that sometimes occurs after drainage of a pericardial effusion for cardiac tamponade. Patients at risk for PDS are difficult to identify. Here, we report 2 cases where PDS developed after drainage of effusions that had been present for years, suggesting that patients with chronic effusions are at higher risk for PDS. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Catherine Sobieski
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Maranda Herner
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Noopur Goyal
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Lillian L. Khor
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiology, Department of Internal Medicine, George E. Wahlen VA Medical Center, Salt Lake City, Utah, USA
| | - Lowell Chang
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiology, Department of Internal Medicine, George E. Wahlen VA Medical Center, Salt Lake City, Utah, USA
| | - Erik Bieging
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiology, Department of Internal Medicine, George E. Wahlen VA Medical Center, Salt Lake City, Utah, USA
| | - Thomas J. McGarry
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiology, Department of Internal Medicine, George E. Wahlen VA Medical Center, Salt Lake City, Utah, USA
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Amro A, Mansoor K, Amro M, Sobeih A, Suliman M, Okoro K, El-Hamdani R, Vilchez D, El-Hamdani M, Shweihat Y
R. A Comprehensive Systemic Literature Review of Pericardial Decompression Syndrome: Often Unrecognized and Potentially Fatal Syndrome. Curr Cardiol Rev 2021; 17:101-110. [PMID: 32515313 PMCID: PMC8142365 DOI: 10.2174/1573403x16666200607184501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pericardial Decompression Syndrome (PDS) is defined as paradoxical hemodynamic deterioration and/or pulmonary edema, commonly associated with ventricular dysfunction. This phenomenon was first described by Vandyke in 1983. PDS is a rare but formidable complication of pericardiocentesis, which, if not managed appropriately, is fatal. PDS, as an entity, has discrete literature; this review is to understand its epidemiology, presentation, and management. METHODOLOGY Medline, Science Direct and Google Scholar databases were utilized to do a systemic literature search. PRISMA protocol was employed. Abstracts, case reports, case series and clinical studies were identified from 1983 to 2019. A total of 6508 articles were reviewed, out of which, 210 were short-listed, and after removal of duplicates, 49 manuscripts were included in this review. For statistical analysis, patient data was tabulated in SPSS version 20. Cases were divided into two categories surgical and percutaneous groups. t-test was conducted for continuous variable and chi-square test was conducted for categorical data used for analysis. RESULTS A total of 42 full-length case reports, 2 poster abstracts, 3 case series of 2 patients, 1 case series of 4 patients and 1 case series of 5 patients were included in the study. A total of 59 cases were included in this manuscript. Our data had 45.8% (n=27) males and 54.2% (n=32) females. The mean age of patients was 48.04 ± 17 years. Pericardiocentesis was performed in 52.5% (n=31) cases, and pericardiostomy was performed in 45.8% (n=27). The most common identifiable cause of pericardial effusion was found to be malignancy in 35.6% (n=21). Twenty-three 23 cases reported pre-procedural ejection fraction, which ranged from 20%-75% with a mean of 55.8 ± 14.6%, while 26 cases reported post-procedural ejection fraction which ranged from 10%-65% with a mean of 30% ± 15.1%. Data was further divided into two categories, namely, pericardiocentesis and pericardiostomy. The outcome as death was significant in the pericardiostomy arm with a p-value of < 0.00. The use of inotropic agents for the treatment of PDS was more common in needle pericardiocentesis with a p-value of 0.04. Lastly, the computed recovery time did not yield any significance with a p-value of 0.275. CONCLUSION Pericardial decompression syndrome is a rare condition with high mortality. Operators performing pericardial drainage should be aware of this complication following drainage of cardiac tamponade, since early recognition and expeditious supportive care are the only therapeutic modalities available for adequate management of this complication.
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Affiliation(s)
- Ahmed Amro
- Address correspondence to this author at the Internal Medicine Department, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA; Tel: 3046544199; E-mail:
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Abstract
Cancer continues to be a leading cause of death despite a broader understanding of its biology and the development of novel therapies. Nonetheless, with an increasing survival of this population, intensivists must be aware of the associated emergencies, both old and new. Oncologic emergencies can be seen as an initial presentation of the disease or precipitated by its treatment. In this review, we present key oncologic emergencies that may be encountered in daily practice, complications associated with innovative therapies, and treatment-related adverse events.
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Affiliation(s)
- Krishna Thandra
- Critical Care Medicine Service, Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zuhair Salah
- Critical Care Medicine Service, Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sanjay Chawla
- Critical Care Medicine Service, Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Kumar A, Puttanna A. Recurrent cardiac tamponade: an initial presentation of lung adenocarcinoma. BMJ Case Rep 2014; 2014:bcr-2013-202553. [PMID: 24850550 DOI: 10.1136/bcr-2013-202553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 63-year-old hypertensive woman presented initially to the surgical team with right upper quadrant pain, the patient was otherwise asymptomatic and clinically well. An abdominal CT scan excluded any surgical diagnoses but rather showed a pericardial effusion. When the cardiology team urgently reviewed her, they found her to be hypotensive and tachycardic with a raised jugular venous pressure. A diagnosis of cardiac tamponade was made and was transferred to the coronary care unit for an emergency pericardiocentesis. She developed tamponade on further occasions requiring pericardiocentesis. The underlying cause was investigated and following pericardial fluid analysis and subsequent imaging, metastatic lung adenocarcinoma was diagnosed.
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