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Sahiti F, Cejka V, Schmidbauer L, Albert J, Kerwagen F, Frantz S, Gelbrich G, Heuschmann PU, Störk S, Morbach C. Prognostic Utility of Pericardial Effusion in the General Population: Findings From the STAAB Cohort Study. J Am Heart Assoc 2024; 13:e035549. [PMID: 38879452 PMCID: PMC11255739 DOI: 10.1161/jaha.124.035549] [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: 03/15/2024] [Accepted: 05/14/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND The incidental finding of a pericardial effusion (PE) poses a challenge in clinical care. PE is associated with malignant conditions or severe cardiac disease but may also be observed in healthy individuals. This study explored the prevalence, determinants, course, and prognostic relevance of PE in a population-based cohort. METHODS AND RESULTS The STAAB (Characteristics and Course of Heart Failure Stages A/B and Determinants of Progression) cohort study recruited a representative sample of the population of Würzburg, aged 30 to 79 years. Participants underwent quality-controlled transthoracic echocardiography including the dedicated evaluation of the pericardial space. Of 4965 individuals included at baseline (mean age, 55±12 years; 52% women), 134 (2.7%) exhibited an incidentally diagnosed PE (median diameter, 2.7 mm; quartiles, 2.0-4.1 mm). In multivariable logistic regression, lower body mass index and higher NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels were associated with PE at baseline, whereas inflammation, malignancy, and rheumatoid disease were not. Among the 3901 participants attending the follow-up examination after a median time of 34 (30-41) months, PE was found in 60 individuals (1.5%; n=18 new PE, n=42 persistent PE). Within the follow-up period, 37 participants died and 93 participants reported a newly diagnosed malignancy. The presence of PE did not predict all-cause death or the development of new malignancy. CONCLUSIONS Incidental PE was detected in about 3% of individuals, with the vast majority measuring <10 mm and completely resolving. PE was not associated with inflammation markers, death, incident heart failure, or malignancy. Our findings corroborate the view of current guidelines that a small PE in asymptomatic individuals can be considered an innocent phenomenon and does not require extensive short-term monitoring.
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Affiliation(s)
- Floran Sahiti
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Vladimir Cejka
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
| | - Lena Schmidbauer
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Institute of Clinical Epidemiology and BiometryUniversity of WurzburgGermany
- Clinical Trial CenterUniversity Hospital and University of WurzburgGermany
| | - Judith Albert
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Fabian Kerwagen
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Stefan Frantz
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Götz Gelbrich
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Institute of Clinical Epidemiology and BiometryUniversity of WurzburgGermany
- Clinical Trial CenterUniversity Hospital and University of WurzburgGermany
| | - Peter U. Heuschmann
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Institute of Clinical Epidemiology and BiometryUniversity of WurzburgGermany
- Clinical Trial CenterUniversity Hospital and University of WurzburgGermany
- Institute of Medical Data ScienceUniversity Hospital WurzburgGermany
| | - Stefan Störk
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Caroline Morbach
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
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Chong A, Stanton T, Taylor A, Prior D, La Gerche A, Anderson B, Scalia G, Cooke J, Dahiya A, To A, Davis M, Mottram P, Moir S, Playford D, Mahadavan D, Thomas L, Wahi S. 2024 CSANZ Position Statement on Indications, Assessment and Monitoring of Structural and Valvular Heart Disease With Transthoracic Echocardiography in Adults. Heart Lung Circ 2024; 33:773-827. [PMID: 38749800 DOI: 10.1016/j.hlc.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 08/22/2023] [Accepted: 11/01/2023] [Indexed: 06/25/2024]
Abstract
Transthoracic echocardiography (TTE) is the most widely available and utilised imaging modality for the screening, diagnosis, and serial monitoring of all abnormalities related to cardiac structure or function. The primary objectives of this document are to provide (1) a guiding framework for treating clinicians of the acceptable indications for the initial and serial TTE assessments of the commonly encountered cardiovascular conditions in adults, and (2) the minimum required standard for TTE examinations and reporting for imaging service providers. The main areas covered within this Position Statement pertain to the TTE assessment of the left and right ventricles, valvular heart diseases, pericardial diseases, aortic diseases, infective endocarditis, cardiac masses, pulmonary hypertension, and cardiovascular diseases associated with cancer treatments or cardio-oncology. Facilitating the optimal use and performance of high quality TTEs will prevent the over or under-utilisation of this resource and unnecessary downstream testing due to suboptimal or incomplete studies.
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Affiliation(s)
- Adrian Chong
- Department of Cardiology, Princess Alexandra Hospital, Mater Hospital Brisbane, University of Queensland, Brisbane, Qld, Australia
| | - Tony Stanton
- Sunshine Coast University Hospital, School of Health University of Sunshine Coast, School of Medicine and Dentistry Griffith University, Birtinya, Qld, Australia
| | - Andrew Taylor
- Department of Cardiology, Royal Melbourne Hospital, Alfred Hospital, Melbourne, Vic, Australia
| | - David Prior
- Albury Wodonga Health, Albury, NSW, Australia
| | - Andre La Gerche
- St Vincent's Hospital, Baker Heart and Diabetes Institute, University of Melbourne, Melbourne, Vic, Australia
| | - Bonita Anderson
- Cardiac Sciences Unit, The Prince Charles Hospital, Queensland University of Technology, Brisbane, Qld, Australia
| | - Gregory Scalia
- The Prince Charles Hospital, University of Queensland, Brisbane, Qld, Australia
| | - Jennifer Cooke
- Department of Cardiology, Eastern Health, Monash University, Melbourne, Vic, Australia
| | - Arun Dahiya
- Department of Cardiology, Princess Alexandra Hospital, Logan Hospital, Griffith University, Brisbane, Qld, Australia
| | - Andrew To
- Department of Cardiology, Health New Zealand Waitemata, Auckland, New Zealand
| | | | - Philip Mottram
- Victorian Heart Institute, Monash University, Melbourne, Vic, Australia
| | - Stuart Moir
- Victorian Heart Institute, Monash University, Melbourne, Vic, Australia
| | | | - Devan Mahadavan
- Department of Cardiology, Queen Elizabeth Hospital, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Westmead Clinical School University of Sydney, South West Clinical School University of New South Wales, Sydney, NSW, Australia
| | - Sudhir Wahi
- Department of Cardiology, Princess Alexandra Hospital, University of Queensland, Brisbane, Qld, Australia.
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Yang H, Hong K, Baraboo JJ, Fan L, Larsen A, Markl M, Robinson JD, Rigsby CK, Kim D. GRASP reconstruction amplified with view-sharing and KWIC filtering reduces underestimation of peak velocity in highly-accelerated real-time phase-contrast MRI: A preliminary evaluation in pediatric patients with congenital heart disease. Magn Reson Med 2024; 91:1965-1977. [PMID: 38084397 PMCID: PMC10950531 DOI: 10.1002/mrm.29974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/27/2023] [Accepted: 11/27/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE To develop a highly-accelerated, real-time phase contrast (rtPC) MRI pulse sequence with 40 fps frame rate (25 ms effective temporal resolution). METHODS Highly-accelerated golden-angle radial sparse parallel (GRASP) with over regularization may result in temporal blurring, which in turn causes underestimation of peak velocity. Thus, we amplified GRASP performance by synergistically combining view-sharing (VS) and k-space weighted image contrast (KWIC) filtering. In 17 pediatric patients with congenital heart disease (CHD), the conventional GRASP and the proposed GRASP amplified by VS and KWIC (or GRASP + VS + KWIC) reconstruction for rtPC MRI were compared with respect to clinical standard PC MRI in measuring hemodynamic parameters (peak velocity, forward volume, backward volume, regurgitant fraction) at four locations (aortic valve, pulmonary valve, left and right pulmonary arteries). RESULTS The proposed reconstruction method (GRASP + VS + KWIC) achieved better effective spatial resolution (i.e., image sharpness) compared with conventional GRASP, ultimately reducing the underestimation of peak velocity from 17.4% to 6.4%. The hemodynamic metrics (peak velocity, volumes) were not significantly (p > 0.99) different between GRASP + VS + KWIC and clinical PC, whereas peak velocity was significantly (p < 0.007) lower for conventional GRASP. RtPC with GRASP + VS + KWIC also showed the ability to assess beat-to-beat variation and detect the highest peak among peaks. CONCLUSION The synergistic combination of GRASP, VS, and KWIC achieves 25 ms effective temporal resolution (40 fps frame rate), while minimizing the underestimation of peak velocity compared with conventional GRASP.
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Affiliation(s)
- Huili Yang
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - KyungPyo Hong
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Justin J Baraboo
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Lexiaozi Fan
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Andrine Larsen
- Department of Biomedical Engineering, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Joshua D Robinson
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Cynthia K Rigsby
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
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Adrian RJ, Alerhand S, Liteplo A, Shokoohi H. Is pulmonary hypertension protective against cardiac tamponade? A systematic review. Intern Emerg Med 2024:10.1007/s11739-024-03566-y. [PMID: 38622465 DOI: 10.1007/s11739-024-03566-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/14/2024] [Indexed: 04/17/2024]
Abstract
The presence of pulmonary hypertension (PH) may affect whether cardiac tamponade physiology develops from a pericardial effusion. Specifically, the increased intracardiac pressure and right ventricular hypertrophy associated with PH would seemingly increase the intrapericardial pressure threshold at which the right-sided chambers collapse. In this systematic review, we examined the impact of PH on the incidence, in-hospital and long-term mortality, and echocardiographic findings of patients with cardiac tamponade. Using the PRISMA guideline, a systematic search was conducted in PubMed, Academic Search Premier, Web of Science, Google Scholar, and the Cochrane Database for studies investigating PH and cardiac tamponade. The Newcastle-Ottawa Scale was used to analyze the quality of returned studies. Primary outcomes included the incidence of cardiac tamponade, as well as in-hospital and long-term mortality rates. Secondary outcomes were the presence or absence of echocardiographic findings of cardiac tamponade in patients with PH. Forty-three studies (9 cohort studies and 34 case reports) with 1054 patients were included. The incidence of cardiac tamponade was significantly higher in patients with PH compared to those without PH, 2.0% (95% CI 1.2-3.2%) vs. 0.05% (95% CI 0.05-0.05%), p < 0.0001, OR 40.76 (95% CI 24.8-66.9). The incidence of tamponade in patients with a known pericardial effusion was similar in those with and without PH, 20.3% (95% CI 12.0-32.3%) and 20.9% (95% CI 18.0-24.1%), p = 0.9267, OR 0.97 (95% CI 0.50-1.87). In patients with tamponade, those with PH demonstrated a significantly higher in-hospital mortality than those without PH, 38.8% (95% CI 26.4-52.8%) vs. 14.4% (95% CI 14.2-14.6%), p < 0.0001, OR 3.77 (95% CI 2.12-6.70). Long-term mortality in patients with tamponade was significantly lower in those with PH than in those without PH, 45.5% (95% CI 33.0-58.5%) vs. 59.1% (95% CI 54.7-63.4%), p = 0.0258, OR 0.576 (95% CI 0.33-1.01). However, after stratifying by non-malignant etiologies, the long-term mortality benefit for those with PH disappeared. In the studies that described specific echocardiographic findings of cardiac tamponade, only 10.5% of patients with PH and tamponade showed right atrial and right ventricular collapse. When evaluating patients with pericardial effusions, physicians must recognize the effects of underlying PH on the incidence, in-hospital and long-term mortality rates, and potentially atypical echocardiographic presentation of cardiac tamponade.
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Affiliation(s)
- Robert James Adrian
- Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
- Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
| | - Stephen Alerhand
- Department of Emergency Medicine, Rutgers New Jersey Medical School, 185 S. Orange Ave, Newark, NJ, 07103, USA
| | - Andrew Liteplo
- Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Hamid Shokoohi
- Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
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Singh Y. Echocardiography in the neonatal unit: current status and future prospects. Expert Rev Med Devices 2024; 21:307-316. [PMID: 38526192 DOI: 10.1080/17434440.2024.2334449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Traditionally echocardiography was used by pediatric cardiologists to diagnose congenital heart defects in neonates. Formalized neonatal hemodynamic fellowships have been established where neonatologists acquire advanced echocardiographic skills to gain anatomical, physiological, and hemodynamic information in real time and utilize this information in making a timely and accurate physiology-based clinical decision. AREA COVERED Differences between a comprehensive formal structural echocardiography, neonatologist performed targeted echocardiography and limited assessment on point-of-care-ultrasonography for specific indications have been covered. This article is focused at providing a comprehensive review of the status of echocardiography in the neonatal units, recent advancements and its future prospects in the neonatal intensive care units. EXPERT OPINION Comprehensive guidelines providing the scope of practice, a framework for training, and robust clinical governance process for the neonatologist performed targeted echocardiography have been established. In the last decade, echocardiography has emerged as essential vital bedside diagnostic tool in providing high-quality care to the sick infants in the neonatal units, and it has proved to improve the outcomes in neonates. It is now being considered as a modern hemodynamic monitoring tool. Advances in technology, machine learning, and application of artificial intelligence in applications of echocardiography seem promising adjunct tools for rapid assessment in emergency situations.
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Affiliation(s)
- Yogen Singh
- Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Division of Neonatology, University of Southern California, Los Angeles, USA
- Department of Pediatrics, University of Cambridge Clinical School of Medicine, Cambridge, UK
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Yuriditsky E, Horowitz JM. The physiology of cardiac tamponade and implications for patient management. J Crit Care 2024; 80:154512. [PMID: 38154410 DOI: 10.1016/j.jcrc.2023.154512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 12/30/2023]
Abstract
Exceeding the limit of pericardial stretch, intrapericardial collections exert compression on the right heart and decrease preload. Compensatory mechanisms ensue to maintain hemodynamics in the face of a depressed stroke volume but are outstripped as disease progresses. When constrained within a pressurized pericardial space, the right and left ventricles exhibit differential filling mediated by changes in intrathoracic pressure. Invasive hemodynamics and echocardiographic findings inform on the physiologic effects. In this review, we describe tamponade physiology and implications for supportive care and effusion drainage.
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Affiliation(s)
- Eugene Yuriditsky
- Division of Cardiology, Department of Medicine, NYU Langone Medical Center, New York, NY 10016, United States of America.
| | - James M Horowitz
- Division of Cardiology, Department of Medicine, NYU Langone Medical Center, New York, NY 10016, United States of America
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Yan A, Ford KS, Faloye AO. Superior Vena Cava Rupture Complicated by Cardiac Tamponade. J Cardiothorac Vasc Anesth 2024; 38:788-791. [PMID: 38184382 DOI: 10.1053/j.jvca.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 01/08/2024]
Affiliation(s)
- Amy Yan
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Emory University, Atlanta, GA
| | - Korrin Scott Ford
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Emory University, Atlanta, GA
| | - Abimbola O Faloye
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Emory University, Atlanta, GA.
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Shmueli H, Shah M, Patel Y, Nguyen LC, Hardy H, Rader F, Siegel RJ. Effects of pericardiocentesis on renal function and cardiac hemodynamics. Echocardiography 2024; 41:e15764. [PMID: 38345414 DOI: 10.1111/echo.15764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Previous case studies have reported reversal of acute renal failure after pericardiocentesis in pericardial effusion. This study examines the effects of pericardiocentesis on preprocedural low cardiac output and acute renal dysfunction in patients with pericardial effusion. METHODS This is a retrospective study of 95 patients undergoing pericardiocentesis between 2015 and 2020. Pre- and post-procedure transthoracic echocardiograms (TTE) were reviewed for evidence of cardiac tamponade, resolution of pericardial effusion, and for estimation of right atrial (RA) pressure and cardiac output. Laboratory values were compared at presentation and post-procedure. Patients on active renal replacement therapy were excluded. RESULTS Ninety-five patients were included for analysis (mean age 62.2 ± 17.8 years, 58% male). There was a significant increase in glomerular filtration rate pre- and post-procedure. Fifty-six patients (58.9%) had an improvement in glomerular filtration rate after pericardiocentesis (termed "responders"), and these patients had a lower pre-procedure glomerular filtration rate than "non-responders." There was a significant improvement in estimated cardiac output and right atrial pressure for patients in both groups. Patients who had an improvement in renal function had significantly lower pre-procedural diastolic blood pressure and mean arterial pressure. CONCLUSIONS Pericardial drainage may improve effusion-mediated acute renal dysfunction by reducing right atrial pressure and thus systemic venous congestion, and by increasing forward stroke volume and perfusion pressure.
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Affiliation(s)
- Hezzy Shmueli
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
- Department of Cardiology, Soroka University Medical Center, Beer Sheva, Israel
| | - Maulin Shah
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Yatindra Patel
- Department of Internal Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Long-Co Nguyen
- Department of Internal Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Hannah Hardy
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Florian Rader
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Robert J Siegel
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
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Butcher A, Castillo C. Point-of-Care Echocardiographic Evaluation of the Pericardium. Semin Ultrasound CT MR 2024; 45:84-90. [PMID: 38056788 DOI: 10.1053/j.sult.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Acute pericardial conditions, such as tamponade, are often rapidly progressive and can become life-threatening without timely diagnosis and intervention. In this review, we aim to describe bedside ultrasonographic evaluation of the pericardium and diagnostic criteria for tamponade, identify confounders in the diagnosis of pericardial tamponade, and delineate procedural details of ultrasound-guided pericardiocentesis.
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Affiliation(s)
- Amy Butcher
- Department of Cardiothoracic and Thoracic Surgery, South Shore University Hospital, Northwell Health, 305 E Main St., Bay Shore, NY 11706.
| | - Cesar Castillo
- Department of Anesthesia and Critical Care, Baylor College of Medicine, Baylor St. Luke's Medical Center, 6720 Bertner Ave, Houston, TX 77030
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Ravikumar DB, Sivasubramanian BP, Singla A, Venu R, Shekar SP. Shorter antitubercular therapy for extrapulmonary tuberculosis - a case report. BMC Infect Dis 2024; 24:86. [PMID: 38225554 PMCID: PMC10788989 DOI: 10.1186/s12879-023-08941-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 12/20/2023] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION Extrapulmonary tuberculosis (EPTB) adds to India's significant economic burden, with pericardial effusion being a potentially fatal complication. This case report highlights the need for early diagnosis and the feasibility of shorter-duration treatment for EPTB in developing countries. PRESENTATION This case report describes a 19-year-old male from Southeast Asia who had a history of bronchiectasis involving the left lower lobe and the right middle lobe, which was cystic in nature, as well as multiple episodes of non-tuberculous pneumonia. Currently, he presented with fever, hypotension, tachycardia, and acute kidney injury. Echocardiogram showed left ventricular dysfunction with a left ventricular ejection fraction (LVEF) of 45% and moderate pericardial effusion. Early signs of cardiac tamponade were noted, specifically the absence of respiratory variation in the right ventricle and left ventricle collapse. Emergent pericardiocentesis was performed, and hemorrhagic pericardial fluid was aspirated. Fluid analysis revealed high levels of LDH (5000 U/L), polymorphonuclear leukocytosis, and acid-fast bacilli that were visualized on microscopy, which led to the diagnosis of pericardial tuberculosis. A CT of the abdomen showed hepatosplenomegaly and polyserositis. Empirically, antitubercular therapy consisting of isoniazid, rifampin, pyrazinamide, and ethambutol was administered for 2 months and isoniazid along with rifampicin was given for the next 4 months. Serial echocardiograms in the following months showed an improvement in LVEF (55%) and decreased effusion. However, during this treatment period, due to frequent episodes of pneumonia, the evaluation of immunodeficiency disorders was performed and revealed low levels of IgG (4.741 g/L), IgA (0.238 g/L), and IgM (0.098 g/L). He was diagnosed with common variable immunodeficiency disease and received intravenous immunoglobulin therapy. CONCLUSION This report emphasizes the timely identification of cardiac tamponade and the effective management of EPTB through a shorter-than-recommended course of antitubercular therapy, resulting in the alleviation of symptoms and better overall health outcomes.
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Affiliation(s)
| | | | - Ankur Singla
- Internal Medicine, Dayanand Medical College & Hospital, Ludhiana, Punjab, 141001, India
| | - Rakshaya Venu
- Internal Medicine, Saveetha Medical College and Hospital, Chennai, Tamilnadu, India.
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Selvakumar D, Barry MA, Pouliopoulos J, Lu J, Tran V, Kovoor P. Intra-cardiac motion detection catheter for the early identification of acute pericardial tamponade during invasive cardiac procedures. Front Cardiovasc Med 2024; 11:1341202. [PMID: 38283830 PMCID: PMC10810984 DOI: 10.3389/fcvm.2024.1341202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
Objectives To develop and test an intra-cardiac catheter fitted with accelerometers to detect acute pericardial effusion prior to the onset of hemodynamic compromise. Background Early detection of an evolving pericardial effusion is critical in ensuring timely treatment. We hypothesized that the reduction in movement of the lateral heart border present in developing pericardial effusions could be quantified by positioning an accelerometer in a lateral cardiac structure. Methods A "motion detection" catheter was created by implanting a 3-axis accelerometer at the distal tip of a cardiac catheter. The pericardial space of 5 adult sheep was percutaneously accessed, and pericardial tamponade was created by infusion of normal saline. The motion detection catheter was positioned in the coronary sinus. Intracardiac echocardiography was used to confirm successful creation of pericardial effusion and hemodynamic parameters were collected. Results Statistically significant reduction in acceleration from baseline was detected after infusion of only 40 ml of normal saline (p < 0.05, ANOVA). In comparison, clinically significant change in systolic blood pressure (defined as >10% drop in baseline systolic blood pressure) occurred after infusion of 80 ml of normal saline (107 ± 22 mmHg vs. 90 ± 12 mmHg p = 0.97, ANOVA), and statistically significant change was recorded only after infusion of 200 ml (107 ± 22 mmHg vs. 64 ± 5 mmHg, p < 0.05, ANOVA). Conclusions An intra-cardiac motion detection catheter is highly sensitive in identifying acute cardiac tamponade prior to clinically and statistically significant changes in systolic blood pressure, allowing for early detection and treatment of this potentially life-threatening complication of all modern percutaneous cardiac interventions.
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Affiliation(s)
- Dinesh Selvakumar
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Michael A. Barry
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
- Faculty of Engineering and IT, University of Sydney, Sydney, NSW, Australia
| | - Jim Pouliopoulos
- Innovation Centre & Clinical Imaging Facility, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- School of Clinical Medicine, UNSW, Sydney, NSW, Australia
| | - Juntang Lu
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
| | - Vu Tran
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
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12
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Glazyrina A, Zholobova E, Iakovleva E, Bobkova P, Krasnaya E, Kovygina K, Romanova O, Blyuss O, Tutelman K, Petrova P, Bairashevskaia A, Rumyantsev M, Korsunskiy AA, Kondrikova E, Nargizyan A, Yusupova V, Korobyants E, Sologub A, Kurbanova S, Suvorov A, Sigfrid L, Buonsenso D, Peroni DG, McArdle AJ, Comberiati P, Munblit D. Short-term and medium-term clinical outcomes of multisystem inflammatory syndrome in children: a prospective observational cohort study. Ital J Pediatr 2024; 50:1. [PMID: 38178192 PMCID: PMC10768316 DOI: 10.1186/s13052-023-01569-7] [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: 09/16/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Even though the incidence of Multisystem Inflammatory Syndrome in children (MIS-C) is decreasing cases are still reported across the world. Studying the consequences of MIS-C enhances our understanding of the disease's prognosis. The objective of this study was to assess short- and medium-term clinical outcomes of MIS-C. METHODS Prospective observational cohort study at Municipal Children's Hospital Morozovskaya, Moscow, Russia. All children meeting the Royal College of Paediatrics and Child Health (RCPCH), Centers for Disease Control and Prevention (CDC), or the World Health Organization (WHO) MIS-C case definition admitted to the hospital between 17 May and 26 October 2020 were included in the study. All survivors were invited to attend a clinic at 2 and 6 weeks after hospital discharge. RESULTS 37 children median age 6 years (interquartile range [IQR] 3.3-9.4), 59.5% (22/37) boys were included in the study. 48.6% (18/37) of patients required ICU care. One child died. All children had increased levels of systemic inflammatory markers during the acute event. Echocardiographic investigations identified abnormal findings in 35.1% (13/37) of children. 5.6% (2/36) of children were presenting with any symptoms six weeks after discharge. By six weeks the inflammatory markers were within the reference norms in all children. The echocardiographic evaluation showed persistent coronary dilatation in one child. CONCLUSIONS Despite the severity of their acute MIS-C, the majority of children in our cohort fully recovered with none having elevated laboratory markers of inflammation at 6 weeks, few (< 10%) reporting persistent symptoms at 6 weeks, and only one with persistent echocardiographic abnormalities.
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Affiliation(s)
- Anastasia Glazyrina
- Morozovskaya Children's Municipal Clinical Hospital of the Moscow City Health Department, Moscow, Russia
| | - Elena Zholobova
- Department of Children Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| | - Ekaterina Iakovleva
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Polina Bobkova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ekaterina Krasnaya
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Karina Kovygina
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Olga Romanova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Oleg Blyuss
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Centre for Prevention, Detection and Diagnosis, Queen Mary University of London, London, UK
| | - Konstantin Tutelman
- Veltischev Clinical Pediatric Research Institute of Pirogov Russian National Research Medical University, Moscow, Russia
| | - Polina Petrova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anastasiia Bairashevskaia
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Mikhail Rumyantsev
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anatoliy A Korsunskiy
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Elena Kondrikova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anzhelika Nargizyan
- Morozovskaya Children's Municipal Clinical Hospital of the Moscow City Health Department, Moscow, Russia
| | - Valeriya Yusupova
- Morozovskaya Children's Municipal Clinical Hospital of the Moscow City Health Department, Moscow, Russia
| | - Evgeniya Korobyants
- Morozovskaya Children's Municipal Clinical Hospital of the Moscow City Health Department, Moscow, Russia
| | - Anna Sologub
- Morozovskaya Children's Municipal Clinical Hospital of the Moscow City Health Department, Moscow, Russia
| | - Seda Kurbanova
- Morozovskaya Children's Municipal Clinical Hospital of the Moscow City Health Department, Moscow, Russia
| | - Aleksandr Suvorov
- World-Class Research Center "Digital biodesign and personalized healthcare", Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Louise Sigfrid
- ISARIC Global Support Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diego G Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Andrew James McArdle
- Department of Infectious Disease, Section of Pediatric Infectious Disease, Imperial College London, London, UK
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy.
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
- Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia.
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13
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Nair R, Zuo J, Shiloh AL. The Importance of Serial POCUS Exams - Dual Pathologies in Play. POCUS JOURNAL 2023; 8:124-125. [PMID: 38099166 PMCID: PMC10721285 DOI: 10.24908/pocus.v8i2.16595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Serial point of care ultrasound (POCUS) exams are essential to assess acute pericardial effusions which can rapidly evolve into cardiac tamponade. A typical presentation includes dyspnea, tachycardia, and chest pain. Importantly, serial cardiac exams in such high-risk patients can detect other concurrent pathologies. We present an unusual case of a patient who initially presented with an acute circumferential pericardial effusion and upon serial POCUS exams developed an unexpected Takotsubo cardiomyopathy in the setting of cardiac tamponade.
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Affiliation(s)
- Rahul Nair
- Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of MedicineBronx, NYUSA
| | | | - Ariel L Shiloh
- Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of MedicineBronx, NYUSA
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14
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Flower L, Arrowsmith JE, Bewley J, Cook S, Cooper G, Flower J, Greco R, Sadeque S, Madhivathanan PR. Management of acute aortic dissection in critical care. J Intensive Care Soc 2023; 24:409-418. [PMID: 37841293 PMCID: PMC10572474 DOI: 10.1177/17511437231162219] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Aortic dissections are associated with significant mortality and morbidity, with rapid treatment paramount. They are caused by a tear in the intimal lining of the aorta that extends into the media of the wall. Blood flow through this tear leads to the formation of a false passage bordered by the inner and outer layers of the media. Their diagnosis is challenging, with most deaths caused by aortic dissection diagnosed at post-mortem. Aortic dissections are classified by location and chronicity, with management strategies depending on the nature of the dissection. The Stanford method splits aortic dissections into type A and B, with type A dissections involving the ascending aorta. De Bakey classifies dissections into I, II or III depending on their origin and involvement and degree of extension. The key to diagnosis is early suspicion, appropriate imaging and rapid initiation of treatment. Treatment focuses on initial resuscitation, transfer (if possible and required) to a suitable specialist centre, strict blood pressure and heart rate control and potentially surgical intervention depending on the type and complexity of the dissection. Effective post-operative care is extremely important, with awareness of potential post-operative complications and a multi-disciplinary rehabilitation approach required. In this review article we will discuss the aetiology and classifications of aortic dissection, their diagnosis and treatment principles relevant to critical care. Critical care clinicians play a key part in all these steps, from diagnosis through to post-operative care, and thus a thorough understanding is vital.
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Affiliation(s)
- Luke Flower
- Central London School of Anaesthesia, London, UK
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Joseph E Arrowsmith
- Department of Anaesthesia, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
- Association for Cardiothoracic Anaesthesia and Critical Care, UK
| | - Jeremy Bewley
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Samantha Cook
- The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Graham Cooper
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jake Flower
- Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Renata Greco
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Syed Sadeque
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Pradeep R Madhivathanan
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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15
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Daar JA, Rali PM. As Simple as IVC? An Unsettling Instance of Pericardial Effusion and Hypotension. Ann Am Thorac Soc 2023; 20:1521-1527. [PMID: 37772938 DOI: 10.1513/annalsats.202304-368cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/03/2023] [Indexed: 09/30/2023] Open
Affiliation(s)
| | - Parth M Rali
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pennsylvania
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16
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Moody WE, Turvey-Haigh L, Knight D, Coats CJ, Cooper RM, Schofield R, Robinson S, Harkness A, Oxborough DL, Gillmore JD, Whelan C, Augustine DX, Fontana M, Steeds RP. British Society of Echocardiography guideline for the transthoracic echocardiographic assessment of cardiac amyloidosis. Echo Res Pract 2023; 10:13. [PMID: 37653443 PMCID: PMC10468878 DOI: 10.1186/s44156-023-00028-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023] Open
Abstract
These guidelines form an update of the BSE guideline protocol for the assessment of restrictive cardiomyopathy (Knight et al. in Echo Res Prac, 2013). Since the original recommendations were conceived in 2013, there has been an exponential rise in the diagnosis of cardiac amyloidosis fuelled by increased clinician awareness, improvements in cardiovascular imaging as well as the availability of new and effective disease modifying therapies. The initial diagnosis of cardiac amyloidosis can be challenging and is often not clear-cut on the basis of echocardiography, which for most patients presenting with heart failure symptoms remains the first-line imaging test. The role of a specialist echocardiographer will be to raise the suspicion of cardiac amyloidosis when appropriate, but the formal diagnosis of amyloid sub-type invariably requires further downstream testing. This document seeks to provide a focused review of the literature on echocardiography in cardiac amyloidosis highlighting its important role in the diagnosis, prognosis and screening of at risk individuals, before concluding with a suggested minimum data set, for use as an aide memoire when reporting.
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Affiliation(s)
- William E Moody
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK.
- Institute of Cardiovascular Science, College of Medical and Dental Science, University of Birmingham, Birmingham, UK.
| | - Lauren Turvey-Haigh
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Daniel Knight
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | | | - Robert M Cooper
- Liverpool Heart and Chest Hospital, Liverpool, UK
- Liverpool John Moores University, Liverpool, UK
| | | | | | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Essex, UK
| | - David L Oxborough
- Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Julian D Gillmore
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Carol Whelan
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Daniel X Augustine
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department For Health, University of Bath, Bath, UK
| | - Marianna Fontana
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Richard P Steeds
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
- Institute of Cardiovascular Science, College of Medical and Dental Science, University of Birmingham, Birmingham, UK
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17
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Cheng CY, Wu CC, Chen HC, Hung CH, Chen TY, Lin CHR, Chiu IM. Development and validation of a deep learning pipeline to measure pericardial effusion in echocardiography. Front Cardiovasc Med 2023; 10:1195235. [PMID: 37600054 PMCID: PMC10436508 DOI: 10.3389/fcvm.2023.1195235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives The aim of this study was to develop a deep-learning pipeline for the measurement of pericardial effusion (PE) based on raw echocardiography clips, as current methods for PE measurement can be operator-dependent and present challenges in certain situations. Methods The proposed pipeline consisted of three distinct steps: moving window view selection (MWVS), automated segmentation, and width calculation from a segmented mask. The MWVS model utilized the ResNet architecture to classify each frame of the extracted raw echocardiography files into selected view types. The automated segmentation step then generated a mask for the PE area from the extracted echocardiography clip, and a computer vision technique was used to calculate the largest width of the PE from the segmented mask. The pipeline was applied to a total of 995 echocardiographic examinations. Results The proposed deep-learning pipeline exhibited high performance, as evidenced by intraclass correlation coefficient (ICC) values of 0.867 for internal validation and 0.801 for external validation. The pipeline demonstrated a high level of accuracy in detecting PE, with an area under the receiving operating characteristic curve (AUC) of 0.926 (95% CI: 0.902-0.951) for internal validation and 0.842 (95% CI: 0.794-0.889) for external validation. Conclusion The machine-learning pipeline developed in this study can automatically calculate the width of PE from raw ultrasound clips. The novel concepts of moving window view selection for image quality control and computer vision techniques for maximal PE width calculation seem useful in the field of ultrasound. This pipeline could potentially provide a standardized and objective approach to the measurement of PE, reducing operator-dependency and improving accuracy.
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Affiliation(s)
- Chi-Yung Cheng
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Cheng-Ching Wu
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | | | - Tien-Yu Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chun-Hung Richard Lin
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - I-Min Chiu
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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18
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Anthony JA, Williams K. Haemorrhagic Mycobacterium avium complex pericarditis presenting with cardiac tamponade in an immunocompetent woman. BMJ Case Rep 2023; 16:e255237. [PMID: 37407234 DOI: 10.1136/bcr-2023-255237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
A young woman in her mid-40s was referred by her primary care physician for fever, worsening shortness of breath, pleuritic chest pain and tachycardia. CT angiogram of the chest revealed a large pericardial effusion. Echocardiogram confirmed tamponade physiology despite her being haemodynamically stable. She had an emergency pericardiocentesis which revealed evidence of a haemorrhagic pericardial effusion. However, the patient was still symptomatic after treatment and had to undergo video-assisted thoracoscopic surgery with a pericardial window and chest tube. Postoperatively, her fevers resolved. Pan-culture was initially negative, and all antibiotics were discontinued. Acid-fast bacilli cultures later grew Mycobacterium avium complex. She continued to have chest discomfort postoperatively, but follow-up CT of the chest 3 months postoperatively showed continued resolution of her pericardial effusion. The patient's symptoms improved, and she has had no recurrence of effusion without the need for anti-tuberculosis drugs.
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Affiliation(s)
- Jamal A Anthony
- Internal Medicine Department, Overlook Medical Center-Atlantic Health System, Summit, New Jersey, USA
| | - Karlene Williams
- Internal Medicine Department, Overlook Medical Center-Atlantic Health System, Summit, New Jersey, USA
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19
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Money DB, Mehio M, Scoma C, Gupta S. Cardiac Point-of-Care Ultrasound (P.O.C.U.S.) Utilization for Hospitalists in the Assessment of Patients with Cardiac Complaints: An Educational Overview. J Community Hosp Intern Med Perspect 2023; 13:1-8. [PMID: 37868243 PMCID: PMC10589009 DOI: 10.55729/2000-9666.1217] [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: 02/15/2023] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 10/24/2023] Open
Abstract
The use of cardiac point-of-care ultrasound (P.O.C.U.S.) is underutilized in the field of internal medicine for the assessment of patients with cardiac complaints. Numerous studies in emergency medicine, anesthesia, and critical care have demonstrated the successful application of cardiac P.O.C.U.S. in resident and attending physicians with limited prior exposure. This article review overviews the practical implementation of cardiac P.O.C.U.S. for hospitalists by discussing proper technique and assessment for common pathology seen in the medical ward setting. We describe how to assess for left ventricular (LV) systolic function, right ventricular (RV) systolic function, suspected acute coronary syndrome (ACS), post-myocardial infarction (MI) complications, suspected pulmonary embolus, and assessment of intravascular volume status. In each section, we overview the pertinent literature to show how cardiac P.O.C.U.S. has been used to directly impact patient care.
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Affiliation(s)
- David B. Money
- Department of Internal Medicine, University of South Florida, Tampa, FL,
USA
| | - Mohammad Mehio
- Department of Internal Medicine, University of South Florida, Tampa, FL,
USA
| | - Christopher Scoma
- Division of Cardiovascular Sciences, University of South Florida, Tampa, FL,
USA
| | - Shanu Gupta
- Department of Internal Medicine, University of South Florida, Tampa, FL,
USA
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20
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Messina Alvarez AA, Bilal MA, Manasrah N, Chaudhary A. Iatrogenic Cardiac Tamponade Secondary to Central Venous Catheter Placement: A Literature Review. Cureus 2023; 15:e37695. [PMID: 37206520 PMCID: PMC10191201 DOI: 10.7759/cureus.37695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Cardiac tamponade is the fluid accumulation within the pericardial sac that compresses the heart and decreases cardiac output. More than 20% of the cases are surgical or non-surgical iatrogenic causes. Cardiac tamponade has been described as a rare complication of central venous catheter placement with an incidence in adults as low as less than 1% but with significantly high mortality of more than 60%. The purpose of this article is to review the incidence, clinical manifestations, pathophysiology, diagnosis, and management of cardiac tamponade after central venous catheter placement as well as different methods to prevent this fatal complication from occurring.
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Affiliation(s)
| | - Mohammad A Bilal
- Internal Medicine, Detroit Medical Center (DMC) Sinai-Grace Hospital, Detroit, USA
| | - Nouraldeen Manasrah
- Internal Medicine, Detroit Medical Center (DMC) Sinai-Grace Hospital, Detroit, USA
| | - Ahmed Chaudhary
- Internal Medicine, Detroit Medical Center (DMC) Sinai-Grace Hospital, Detroit, USA
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21
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Weber MD, Lim JKB, Ginsburg S, Conlon T, Nishisaki A. Translating Guidelines into Practical Practice: Point-of-Care Ultrasound for Pediatric Critical Care Clinicians. Crit Care Clin 2023; 39:385-406. [PMID: 36898781 DOI: 10.1016/j.ccc.2022.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Point-of-care ultrasound (POCUS) is now transitioning from an emerging technology to a standard of care for critically ill children. POCUS can provide immediate answers to clinical questions impacting management and outcomes within this fragile population. Recently published international guidelines specific to POCUS use in neonatal and pediatric critical care populations now complement previous Society of Critical Care Medicine guidelines. The authors review consensus statements within guidelines, identify important limitations to statements, and provide considerations for the successful implementation of POCUS in the pediatric critical care setting.
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Affiliation(s)
- Mark D Weber
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Joel K B Lim
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore
| | - Sarah Ginsburg
- Division of Critical Care Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Conlon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Akira Nishisaki
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
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22
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van Dinter S, Li W, Wollersheim L, Rodwell L, van Royen N, Dieker HJ, Verhagen A. Variations in current clinical practice of postoperative pericardial effusion: a questionnaire study. Open Heart 2023; 10:openhrt-2023-002271. [PMID: 37094990 PMCID: PMC10152046 DOI: 10.1136/openhrt-2023-002271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/31/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE Postoperative pericardial effusion (PPE) occurs frequently after cardiac surgery, potentially leading to life-threatening cardiac tamponade. Specific treatment guidelines are currently lacking, possibly leading to variations in clinical practice. Our goal was to assess clinical PPE management and evaluate variation between centres and clinicians. METHODS A nationwide survey was sent to all interventional cardiologists and cardiothoracic surgeons in the Netherlands, regarding their preferred diagnostic and treatment modality of PPE. Clinical preferences were explored utilising four patient scenarios, each with a high/low echocardiographic and clinical suspicion of cardiac tamponade. Scenarios were also stratified by three PPE sizes (<1 cm, 1-2 cm, >2 cm). RESULTS In total, 46/140 interventional cardiologists and 48/120 cardiothoracic surgeons responded (27/31 contacted centres). Cardiologists favoured routine postoperative echocardiography in all patients (44%), whereas cardiothoracic surgeons preferred routine imaging after specific procedures, especially mitral (85%) and tricuspid (79%) valve surgery. Overall, pericardiocentesis (83%) was preferred over surgical evacuation (17%). Regarding all patient scenarios, cardiothoracic surgeons significantly preferred evacuation compared with cardiologists (51% vs 37%, p<0.001). This was also observed with cardiologists employed in surgical centres compared with non-surgical centres (43% vs 31%, p=0.02). Inter-rater analysis varied from poor to near-excellent (к 0.22-0.67), suggesting varying PPE treatment preferences within one centre. CONCLUSION There is significant variation in the preferred management of PPE between hospitals and clinicians, even within the same centre, possibly due to the lack of specific guidelines. Therefore, robust results of a systematic approach to PPE diagnosis and treatment are needed to formulate evidence-based recommendations and optimise patient outcome.
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Affiliation(s)
| | - Wilson Li
- Cardiothoracic Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Laurens Wollersheim
- Cardiothoracic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Laura Rodwell
- Department for Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | | | | | - Ad Verhagen
- Cardiothoracic Surgery, Radboudumc, Nijmegen, The Netherlands
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23
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Risk Factors for Symptomatic Pericardial Effusions Posthematopoietic Stem Cell Transplant. J Transplant 2023; 2023:7455756. [PMID: 36818524 PMCID: PMC9931484 DOI: 10.1155/2023/7455756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 01/05/2023] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Background Pericardial effusions are a known complication posthematopoietic stem cell transplant (HSCT), causing significant morbidity. We aimed to evaluate the risk factors associated with the development of high-grade effusions requiring interventions. Procedure. A retrospective chart review of all HSCT patients over a period of 7 years (2013-2019) in a single institution in the Northeastern United States is conducted. All patients who developed an effusion requiring intervention were included. Patient's clinical characteristics were compared with all others transplanted during the same time period. Echocardiogram findings of the affected patients were compared to a case-control cohort of unaffected patients with similar age and diagnosis. Chi-square and paired t-tests were utilized to ascertain statistical differences between the groups. Results A total of 15 patients out of 201 (7.5%) transplanted at our institution developed a moderate or large pericardial effusion requiring pericardiocentesis or a pericardial window. Of this cohort, 13 (87%) underwent a myeloablative preparative regimen, 13 (87%) had cyclophosphamide as part of their regimen, 13 (87%) had recent treatment for viral reactivation, 6 (40%) had an underlying hemoglobinopathy diagnosis, and only 4 (27%) had an active diagnosis of GVHD. A myeloablative preparative regimen had a higher rate of effusion requiring intervention, although it was not statistically significant, and concurrent GVHD was not predictive of effusion development. However, exposure to cyclophosphamide, recent treatment for viral reactivation, and a diagnosis of transplant-associated thrombotic microangiopathy (Ta-TMA) were highly associated with effusions. The latter was associated with increased mortality. The duration of pericardial effusion correlated with the pretransplant echocardiogram left ventricle end diastolic diameter z-score and apical 4-chamber left ventricular peak average strain measurement. Conclusions Potential risk factors for pericardial effusions post-HSCT include a diagnosis of Ta-TMA, active viral infection, exposure to cyclophosphamide, and a higher left ventricle end diastolic diameter z-score. This information may help guide management for these patients, including identifying high-risk subjects, determining the frequency of echocardiograms, and determining specific echocardiogram measures to follow over time.
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Kaemmerer AS, Alkhalaileh K, Suleiman MN, Kopp M, Hauer C, May MS, Uder M, Weyand M, Harig F. Pericardial tamponade, a diagnostic chameleon: from the historical perspectives to contemporary management. J Cardiothorac Surg 2023; 18:60. [PMID: 36739433 PMCID: PMC9898697 DOI: 10.1186/s13019-023-02174-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/28/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pericardial tamponade (PT) early after cardiac surgery is a challenging clinical entity, not infrequently misrecognized and often only detected late in its course. Because the clinical signs of pericardial tamponade can be very unspecific, a high degree of initial suspicion is required to establish the diagnosis. In addition to clinical examination the deployment of imaging techniques is almost always mandatory in order to avoid delays in diagnosis and to initiate any necessary interventions, such as pericardiocentesis or direct cardiac surgical interventions. After a brief overview of how knowledge of PT has developed throughout history, we report on an atypical life-threatening cardiac tamponade after cardiac surgery. A 74-year-old woman was admitted for elective biological aortic valve replacement and aorto-coronary-bypass grafting (left internal mammary artery to left anterior descending artery, single vein graft to right coronary artery). On the 10th postoperative day, the patient unexpectedly deteriorated. She rapidly developed epigastric pain radiating to the left upper abdomen, and features of low peripheral perfusion and shock. There were no clear signs of pericardial tamponade either clinically or echocardiographically. Therefore, for further differential diagnosis, a contrast-enhanced computed tomography scan was performed under clinical suspicion of acute abdomen. Unexpectedly, active bleeding distally from the right coronary anastomosis was revealed. While the patient was prepared for operative revision, she needed cardiopulmonary resuscitation, which was successful. Intraoperatively, the source of bleeding was located and surgically relieved. The subsequent postoperative course was uneventful. CONCLUSIONS In the first days after cardiac surgery, the occurrence of life-threatening situations, such as cardiac tamponade, must be expected. Especially if the symptoms are atypical, the entire diagnostic armamentarium must be applied to identify the origin of the complaints, which may be cardiac, but also non-cardiac. CENTRAL MESSAGE A high level of suspicion, immediate diagnostic confirmation, and rapid treatment are required to recognize and successfully treat such an emergency (Fig. 5). PERSPECTIVE Pericardial tamponade should always be considered as a complication of cardiac surgery, even when symptoms are atypical. The full range of diagnostic tools must be used to identify the origin of the complaints, which may be cardiac, but also non-cardiac (Fig. 5).
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Affiliation(s)
- Ann-Sophie Kaemmerer
- grid.5330.50000 0001 2107 3311Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Khaleel Alkhalaileh
- grid.5330.50000 0001 2107 3311Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Mathieu N. Suleiman
- grid.5330.50000 0001 2107 3311Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Markus Kopp
- grid.5330.50000 0001 2107 3311Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Christine Hauer
- grid.5330.50000 0001 2107 3311Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias S. May
- grid.5330.50000 0001 2107 3311Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Uder
- grid.5330.50000 0001 2107 3311Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Weyand
- grid.5330.50000 0001 2107 3311Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Frank Harig
- grid.5330.50000 0001 2107 3311Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
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de Vet CM, van Oostrum NHM, Clur SB, van der Woude DAA, Oei SG, van Laar JOEH. Reply. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:275-277. [PMID: 36722426 DOI: 10.1002/uog.26151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 05/27/2023]
Affiliation(s)
- C M de Vet
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - N H M van Oostrum
- Department of Gynaecology and Obstetrics, Ghent University Hospital, Ghent, Belgium
| | - S B Clur
- Department of Paediatric Cardiology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - D A A van der Woude
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
| | - S G Oei
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - J O E H van Laar
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Alkathim A, Alfaraj D, Alghamdi MA, Al-Nahash S. Incidental finding of asymptomatic non-traumatic pericardial effusion in a trauma patient: a case report. J Med Life 2023; 16:167-172. [PMID: 36873114 PMCID: PMC9979186 DOI: 10.25122/jml-2022-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 12/23/2022] [Indexed: 03/07/2023] Open
Abstract
Pericardial effusion can either be an incidental finding or a manifestation of systemic or cardiac disease. It has a wide range of presentations, from asymptomatic small effusion to rapidly progressive fatal tamponade. In a trauma setting, pericardial effusion is usually attributed to hematoma collection, with the concern of clinical evidence of tamponade that can lead to cardiopulmonary collapse. The Focused Assessment with Sonography for Trauma (FAST) is a widely used tool to diagnose pericardial effusion in trauma patients. We published this case report to emphasize that the presence of pericardial effusion alone in a trauma patient does not indicate the presence of tamponade. This case concerns a 39 years old male patient who presented to ER as a trauma case after a fall from two meters height and landing on his feet. ATLS protocol was followed, and FAST showed an incidental finding of massive pericardial fluid. The trauma team was consulted, and the patient was hemodynamically stable without clinical evidence of tamponade. Echocardiography showed mitral valve stenosis and large pericardial effusion. The close observation did not suggest the presence of cardiac tamponade. The pericardial catheter was inserted during admission with drainage of 900cc of serous fluid. The presence of pericardial fluid in a trauma setting does not confirm the diagnosis of tamponade. The mechanism of injury, clinical presentation, and the patient's stability are essential factors in determining further management of such patients.
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Affiliation(s)
- Ahmed Alkathim
- Anesthesia Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Dunya Alfaraj
- Emergency Medicine Department, King Fahad University Hospital, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Mohannad Ali Alghamdi
- Emergency Medicine Department, King Fahad University Hospital, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Samar Al-Nahash
- Emergency Medicine Department, King Fahad University Hospital, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
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Muacevic A, Adler JR. Subacute Cardiac Tamponade With Massive Pericardial Effusion. Cureus 2022; 14:e32250. [PMID: 36620798 PMCID: PMC9815488 DOI: 10.7759/cureus.32250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/12/2022] Open
Abstract
Subacute cardiac tamponade is a diagnostic challenge for clinicians because the symptoms would be non-specific upon presentation. The onset of cardiac tamponade may vary depending on the rate of accumulation and compensatory mechanism of the fibroelastic pericardial sac. In the case of subacute tamponade with effusion without cardiac arrest, it is usually challenging for the clinician to make the decision for urgent drainage. Usually, cardiac tamponade is treated as a medical emergency, and it occurs when fluid accumulated in the pericardial sac compresses the heart causing haemodynamic compromise and cardiac arrest. In our case, a 40-year-old man presented with a seven-day history of significant shortness of breath. He presented to the emergency department and the chest X-ray showed a large cardiac silhouette, which suggested a large pericardial effusion. ECG revealed minor changes in the heights of QRS complexes. Point-of-care echocardiography showed a large pericardial effusion, and he was immediately admitted to the cardiac unit. Urgent departmental echocardiography confirmed massive pericardial effusion with features of subacute tamponade. The patient was sent to the cardiac catheterisation lab and a total of approximately 4.2 litres of pericardial effusion was drained, while he was closely monitored for the risk of rapid physiologic decompensation after drainage. Pericardial fluid culture did not show any evidence of microorganism growth. The connective tissue disease screen was negative. CT scan did not show any stigmata of occult malignancy or features of infection. The coronavirus disease 2019 (COVID-19) polymerase chain reaction test was negative. He had rapid symptomatic improvement after the effusion was drained and recovery was uneventful. He was discharged from the hospital with a follow-up plan. We concluded that it was a case of subacute cardiac tamponade due to a massive pericardial effusion of idiopathic or subclinical viral causes. Clinical presentation of subacute cardiac tamponade could be easily missed, and a detailed assessment of the effusion with echocardiography was very helpful in making decisions for the management.
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Muacevic A, Adler JR. Great Toe Infection Leading to Methicillin-Sensitive Staphylococcus aureus Pericarditis and Tamponade. Cureus 2022; 14:e32951. [PMID: 36712779 PMCID: PMC9875357 DOI: 10.7759/cureus.32951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2022] [Indexed: 12/28/2022] Open
Abstract
Bacterial pericarditis is an uncommon presentation that can occur secondarily to the contiguous spread of infection from an intrathoracic focus, hematogenous seeding from a distant site, or via trauma and intrathoracic surgery. Its presence is linked to a high mortality rate with death generally caused by cardiac tamponade, fulminant sepsis, and acute decompensated heart failure. We describe a rare case of methicillin-sensitive Staphylococcus aureus (MSSA) pericarditis in a patient after great toe amputation; the patient developed cardiac tamponade and required urgent percutaneous pericardiocentesis with the placement of a temporary drain. The patient was then successfully treated with IV antibiotics and did not require further invasive procedures such as surgical pericardiotomy.
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Wang J, Wang Q, Liu Y, Lin Z, Janjua MU, Peng J, Du J. The incidence and mortality rate of catheter-related neonatal pericardial effusion: A meta-analysis. Medicine (Baltimore) 2022; 101:e32050. [PMID: 36451499 PMCID: PMC9704876 DOI: 10.1097/md.0000000000032050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUD Neonatal pericardial effusion (PCE) is one of the most severe complications of central catheters in neonates with its rapid progression and high mortality. We aim to estimate the overall incidence and mortality of catheter-related neonatal PCE, more importantly, to identify possible predictors for clinical reference. METHODS We searched MEDLINE, Embase, Cochrane Library, Web of Science, china national knowledge infrastructure, Wanfang Data, and Sinomed databases for subject words "central catheter," "neonate," "pericardial effusion" and their random words till June 8, 2020. This meta-analysis is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Possible predictors of occurrences and deaths were extracted and assessed cooperatively. The pooled incidence rate of catheter-related neonatal PCE was calculated using a random effects model. RESULTS Twenty-one cohort studies and 99 cases were eligible. Pooled incidence is 3·8‰[2.2‰, 6.7‰]. Polyurethane catheters generate significantly more neonatal PCE than silicone counterparts (P < .01). 27% of the patients die. The mortality of patients with bradycardia is higher than others (P < .05). Catheters with a guidewire result in more deaths than umbilical venous catheter (UVC) and peripherally inserted central catheters (PICC) (P < .05). Without pericardiocentesis, mortality increases (P < .01). The difference of deaths between reposition and removing the catheter is insignificant (P > .05). CONCLUSION Central catheters in Seldinger Technique (with a guidewire) put neonates at greater risk of PCE and consequent death. Silicone catheters excel at avoiding deadly catheter-related PCE, which could be a better choice in neonatal intensive care units (NICU). When catheter-related PCE occurs, timely diagnosis and pericardiocentesis save lives.
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Affiliation(s)
- Jingyi Wang
- The First Clinical Medical Institute, Hainan Medical University, Hainan, China
| | - Qing Wang
- Department of Neonatology, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
| | - Yanxia Liu
- Department of Neonatology, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
| | - Zebin Lin
- Department of Neonatology, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
| | - Muhammad Usman Janjua
- International Education Institute, Changsha Medical University, Changsha, Hunan, China
| | - Jianxiong Peng
- Medical Administration Department, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
| | - Jichang Du
- Department of Neonatology, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
- * Correspondence: Jichang Du, Department of Neonatology, Hainan Modern Women and Children’s Hospital, No. 18 Qiongzhou Avenue, Qiongshan District, Haikou, Hainan 571101, P.R. China (e-mail: )
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Jahmani T, Tuyisenge AM, Bhattacharya S, Lalitha R. Use of multimodality monitoring to guide clinical care in a non-ventilated neonate with pneumopericardium. BMJ Case Rep 2022; 15:e251697. [PMID: 36351677 PMCID: PMC9644298 DOI: 10.1136/bcr-2022-251697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Tamara Jahmani
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Western University, London, Ontario, Canada
| | - Anne-Marie Tuyisenge
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Western University, London, Ontario, Canada
| | - Soume Bhattacharya
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Western University, London, Ontario, Canada
| | - Renjini Lalitha
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Western University, London, Ontario, Canada
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Danta M, Zerzan J. Pericardial Effusion Identified by Point-of-Care Ultrasound in a Pediatric Patient with Covid-19. VISUAL JOURNAL OF EMERGENCY MEDICINE 2022; 29:101462. [PMID: 35855493 PMCID: PMC9283693 DOI: 10.1016/j.visj.2022.101462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/13/2022] [Indexed: 12/02/2022]
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Samaeekia R, Jolly G, Marais R, Amini R, Abramov D, Abudayyeh I. Utility of Handheld Ultrasound Performed by Cardiology Fellows in Patients Presenting with Suspected ST-Elevation Myocardial Infarction. J Cardiovasc Echogr 2022; 32:205-211. [PMID: 36994123 PMCID: PMC10041406 DOI: 10.4103/jcecho.jcecho_51_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/06/2022] [Accepted: 10/02/2022] [Indexed: 03/31/2023] Open
Abstract
Background In academic hospitals, cardiology fellows may be the first point of contact for patients presenting with suspected ST-elevation myocardial infarction (STEMI) or acute coronary syndrome (ACS). In this study, we sought to determine the role of handheld ultrasound (HHU) in patients with suspected acute myocardial injury (AMI) when used by fellows in training, its association with the year of training in cardiology fellowship, and its influence on clinical care. Methods This prospective study's sample population comprised patients who presented to the Loma Linda University Medical Center Emergency Department with suspected acute STEMI. On-call cardiology fellows performed bedside cardiac HHU at the time of AMI activation. All patients subsequently underwent standard transthoracic echocardiography (TTE). The impact of the detection of wall motion abnormalities (WMAs) on HHU in regard to clinical decision-making, including whether the patient would undergo urgent invasive angiography, was also evaluated. Results Eighty-two patients (mean age: 65 years, 70% male) were included. The use of HHU by cardiology fellows resulted in a concordance correlation coefficient of 0.71 (95% confidence interval: 0.58-0.81) between HHU and TTE for left ventricular ejection fraction (LVEF), and a concordance correlation coefficient of 0.76 (0.65-0.84) for wall motion score index. Patients with WMA on HHU were more likely to undergo invasive angiogram during hospitalization (96% vs. 75%, P < 0.01). The time interval between the performance of HHU to initiation of cardiac catheterization (time-to-cath) was shorter in patients with abnormal versus normal HHU examinations (58 ± 32 min vs. 218 ± 388 min, P = 0.06). Finally, among patients who underwent angiography, those with WMA were more likely to undergo angiography within 90 min of presentation (96% vs. 66%, P < 0.001). Conclusion HHU can be reliably used by cardiology fellows in training for measurement of LVEF and assessment of wall motion abnormalities, with good correlation to findings obtained via standard TTE. HHU-identified WMA at first contact was associated with higher rates of angiography as well as sooner angiography compared to patients without WMA.
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Affiliation(s)
- Ravand Samaeekia
- Department of Medicine, Division of Cardiology, Loma Linda Medical Center, Loma Linda, CA, USA
- Department of Internal Medicine, Loma Linda Medical Center, Loma Linda, CA, USA
| | - George Jolly
- Department of Medicine, Division of Cardiology, Loma Linda Medical Center, Loma Linda, CA, USA
| | - Ryan Marais
- Department of Internal Medicine, Loma Linda Medical Center, Loma Linda, CA, USA
| | - Reza Amini
- Department of Medicine, Division of Cardiology, Loma Linda Medical Center, Loma Linda, CA, USA
| | - Dmitry Abramov
- Department of Medicine, Division of Cardiology, Loma Linda Medical Center, Loma Linda, CA, USA
| | - Islam Abudayyeh
- Department of Medicine, Division of Cardiology, Loma Linda Medical Center, Loma Linda, CA, USA
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Abstract
PURPOSE OF REVIEW Thyroid disorders, especially hypothyroidism, are known to be associated with pericardial diseases. The aim of this paper is to review the current knowledge of the pericardial manifestations of hypothyroidism and hyperthyroidism. RECENT FINDINGS Many reports have described associations between dysthyroidism, which encompasses hypothyroidism and hyperthyroidism, and several pericardial diseases, including acute pericarditis, constrictive pericarditis, pericardial effusion, and tamponade. The diagnosis of dysthyroidism-induced pericardial diseases consists of a combination of thyroid blood levels that fall outside of the normal range and the exclusion of other causes. Treatment of the thyroid disorder is key, along with treatment of the pericardial disease as recommended by the guidelines. Early recognition of the thyroid disorder is key in patients with pericardial diseases, since treating the underlying cause should assist resolution of the pericardial issues and ideally prevent recurrence and possible future complications of suboptimally treated pericarditis or pericardial effusions.
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Affiliation(s)
- Johnny Chahine
- Department of Cardiovascular Disease, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Zeina Jedeon
- Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kevin Y Chang
- Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Christine L Jellis
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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Henning RJ. Handheld ultrasound is an adjunct to the physical examination in the diagnosis of cardiopulmonary disease. Future Cardiol 2022; 18:585-600. [PMID: 35543226 DOI: 10.2217/fca-2021-0142] [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: 11/21/2022] Open
Abstract
Handheld 2D ultrasound devices (HUDs) have become available as an adjunct to physical examinations, visualizing the heart and lungs in real time and facilitating prompt patient diagnosis and treatment of cardiopulmonar.y disorders. These devices provide simple and rapid bedside alternatives to repetitive chest x-rays, standard ultrasound examinations and thoracic CT scans. Two currently available HUDs are described. This paper discusses the use of HUDs in the diagnosis of patients with pericardial effusion and tamponade, ventricular dilation, aortic and mitral regurgitation, cardiogenic pulmonary edema, viral and bacterial pneumonia, pleural effusion and pneumothorax. The use of a HUD by physicians increases clinical diagnostic accuracy, adds quantitative information about cardiopulmonary disease severity and guides the use of medications and interventions.
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Partial absence of the pericardium: Only an incidental finding? An Pediatr (Barc) 2022; 96:540-542. [DOI: 10.1016/j.anpede.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/10/2021] [Indexed: 11/24/2022] Open
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Alerhand S, Adrian RJ, Long B, Avila J. Pericardial tamponade: A comprehensive emergency medicine and echocardiography review. Am J Emerg Med 2022; 58:159-174. [DOI: 10.1016/j.ajem.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022] Open
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Demographic, clinical and etiological profile of pericardial effusion in India: A single centre experience. Indian J Tuberc 2022; 69:220-226. [PMID: 35379405 DOI: 10.1016/j.ijtb.2021.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/23/2021] [Accepted: 08/16/2021] [Indexed: 02/05/2023]
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Rangasamy A, Ayyan SM, Ravipragasam S, Sadasivam A. An Elderly Woman With Persistent Chest Pain. Ann Emerg Med 2022; 79:405-417. [PMID: 35337475 DOI: 10.1016/j.annemergmed.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Ajai Rangasamy
- Department of Emergency Medicine & Trauma, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Sugunananthagopan Manu Ayyan
- Department of Emergency Medicine & Trauma, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Surendar Ravipragasam
- Department of Emergency Medicine & Trauma, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Anuusha Sadasivam
- Department of Emergency Medicine & Trauma, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
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Lau YH, See KC. Point-of-care ultrasound for critically-ill patients: A mini-review of key diagnostic features and protocols. World J Crit Care Med 2022; 11:70-84. [PMID: 35433316 PMCID: PMC8968483 DOI: 10.5492/wjccm.v11.i2.70] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/08/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
Point-of-care ultrasonography (POCUS) for managing critically ill patients is increasingly performed by intensivists or emergency physicians. Results of needs surveys among intensivists reveal emphasis on basic cardiac, lung and abdominal ultrasound, which are the commonest POCUS modalities in the intensive care unit. We therefore aim to describe the key diagnostic features of basic cardiac, lung and abdominal ultrasound as practised by intensivists or emergency physicians in terms of accuracy (sensitivity, specificity), clinical utility and limitations. We also aim to explore POCUS protocols that integrate basic cardiac, lung and abdominal ultrasound, and highlight areas for future research.
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Affiliation(s)
- Yie Hui Lau
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Kay Choong See
- Division of Respiratory & Critical Care Medicine, National University Hospital, Singapore 119074, Singapore
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Wieser M, Ringer SK, Baron Toaldo M. Pericardial tamponade during balloon pulmonary valvuloplasty in a dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Manuela Wieser
- Department of Clinical Diagnostics and Services Section of Anaesthesiology Vetsuisse Faculty University of Zurich Zurich Switzerland
| | - Simone Katja Ringer
- Department of Clinical Diagnostics and Services Section of Anaesthesiology Vetsuisse Faculty University of Zurich Zurich Switzerland
| | - Marco Baron Toaldo
- Clinic for Small Animal Internal Medicine Division of Cardiology Vetsuisse Faculty University of Zurich Zurich Switzerland
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Burton L, Bhargava V, Kong M. Point-of-Care Ultrasound in the Pediatric Intensive Care Unit. Front Pediatr 2022; 9:830160. [PMID: 35178366 PMCID: PMC8845897 DOI: 10.3389/fped.2021.830160] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/29/2021] [Indexed: 12/30/2022] Open
Abstract
Ultrasonography has been widely used in medicine for decades but often by specific users such as cardiologists, obstetricians, and radiologists. In the last several years, the use of this imaging modality has moved to the bedside, with clinicians performing and interpreting focused point of care ultrasonography to aid in immediate assessment and management of their patients. The growth of point of care ultrasonography has been facilitated by advancement in ultrasound-related technology and emerging studies and protocols demonstrating its utility in clinical practice. However, considerable challenges remain before this modality can be adopted across the spectrum of disciplines, primarily as it relates to training, competency, and standardization of usage. This review outlines the history, current state, challenges and the future direction of point of care ultrasonography specifically in the field of pediatric critical care medicine.
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Petri CA, Perez Y, Heidenreich LS, Cramer CH, Olson TM, Hull NC, Hanna C. New-onset cough and fever in a toddler with stage 5 chronic kidney disease: Answers. Pediatr Nephrol 2022; 37:123-125. [PMID: 34633530 DOI: 10.1007/s00467-021-05301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Cassandra A Petri
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yalile Perez
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Leah S Heidenreich
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Carl H Cramer
- Division of Pediatric Nephrology and Hypertension, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Timothy M Olson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nathan C Hull
- Division of Pediatric Radiology, Mayo Clinic, Rochester, MN, USA
| | - Christian Hanna
- Division of Pediatric Nephrology and Hypertension, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
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Medium-Term Cardiac Outcomes in Young People with Multi-system Inflammatory Syndrome: The Era of COVID-19. Pediatr Cardiol 2022; 43:1728-1736. [PMID: 35486129 PMCID: PMC9052178 DOI: 10.1007/s00246-022-02907-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/04/2022] [Indexed: 11/06/2022]
Abstract
Multi-system inflammatory syndrome in children (MIS-C) causes widespread inflammation including a pancarditis in the weeks following a COVID infection. As we prepare for further coronavirus surges, understanding the medium-term cardiac impacts of this condition is important for allocating healthcare resources. A retrospective single-center study of 67 consecutive patients with MIS-C was performed evaluating echocardiographic and electrocardiographic (ECG) findings to determine the point of worst cardiac dysfunction during the admission, then at intervals of 6-8 weeks and 6-8 months. Worst cardiac function occurred 6.8 ± 2.4 days after the onset of fever with mean 3D left ventricle (LV) ejection fraction (EF) 50.5 ± 9.8%. A pancarditis was typically present: 46.3% had cardiac impairment; 31.3% had pericardial effusion; 26.8% demonstrated moderate (or worse) valvar regurgitation; and 26.8% had coronary dilatation. Cardiac function normalized in all patients by 6-8 weeks (mean 3D LV EF 61.3 ± 4.4%, p < 0.001 compared to presentation). Coronary dilatation resolved in all but one patient who initially developed large aneurysms at presentation, which persisted 6 months later. ECG changes predominantly featured T-wave changes resolving at follow-up. Adverse events included need for ECMO (n = 2), death as an ECMO-related complication (n = 1), LV thrombus formation (n = 1), and subendocardial infarction (n = 1). MIS-C causes a pancarditis. In the majority, discharge from long-term follow-up can be considered as full cardiac recovery is expected by 8 weeks. The exception includes patients with medium sized aneurysms or greater as these may persist and require on-going surveillance.
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A 37-Year-Old Man With Interstitial Lung Disease and Progressive Dyspnea. Chest 2021; 160:e657-e660. [PMID: 34872681 DOI: 10.1016/j.chest.2021.01.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/05/2020] [Accepted: 01/16/2021] [Indexed: 10/19/2022] Open
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A 73-Year-Old Woman With Pulseless Electrical Activity Arrest. Chest 2021; 160:e665-e667. [PMID: 34872683 DOI: 10.1016/j.chest.2021.03.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/02/2021] [Accepted: 03/24/2021] [Indexed: 11/22/2022] Open
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Abstract
Cardiac point-of-care ultrasound (POCUS) provides real-time views of the heart to answer specific questions in a timely manner. This is a valuable tool for managing pediatric patients, from those with congenital heart disease to those who are critically ill. The main echocardiographic findings of pericardial tamponade consist of a pericardial effusion, diastolic right ventricular collapse, systolic right atrial collapse, and a plethoric inferior vena cava with minimal respiratory variation. The main echocardiographic findings of hypertrophic cardiomyopathy consist of increased wall thickness (concentric or eccentric), systolic anterior motion of the anterior mitral leaflet, and a dynamic sub-aortic left ventricular outflow tract obstruction. Additional uses of cardiac POCUS include assessment of dilated cardiomyopathy and the detection of pediatric congenital heart disease, including detection of a patent ductus arteriosus. The use of POCUS in the pediatric population is supported by societal position statements and is expected to develop further with increasingly robust education and training. [Pediatr Ann. 2021;50(10):e424-e431.].
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Kolli S, Singh M, Chien G. Female With Hypotension. Ann Emerg Med 2021; 78:501-575. [PMID: 34563297 DOI: 10.1016/j.annemergmed.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Shilpa Kolli
- Department of Emergency Medicine, NYC Health and Hospitals/Jacobi Medical Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY
| | - Maninder Singh
- Department of Emergency Medicine, NYC Health and Hospitals/Jacobi Medical Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY
| | - Gordon Chien
- Department of Emergency Medicine, NYC Health and Hospitals/Jacobi Medical Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY
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Argaiz ER, Koratala A, Reisinger N. Comprehensive Assessment of Fluid Status by Point-of-Care Ultrasonography. KIDNEY360 2021; 2:1326-1338. [PMID: 35369665 PMCID: PMC8676400 DOI: 10.34067/kid.0006482020 10.34067/kid.0006482020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 01/10/2024]
Abstract
The management of complex fluid and electrolyte disorders is central to the practice of nephrologists. The sensitivity of physical examination alone to determine fluid status is limited, precluding accurate clinical decision making. Point-of-care ultrasonography (POCUS) is emerging as a valuable, noninvasive, bedside diagnostic tool for objective evaluation of physiologic and hemodynamic parameters related to fluid status, tolerance, and responsiveness. Rapid bedside sonographic evaluation can obtain qualitative data on cardiac function and quantitative data on pulmonary congestion. Advanced POCUS, including goal-directed Doppler echocardiography, provides additional quantitative information, including flow velocities and pressures across the cardiac structures. Recently, abnormal Doppler flow patterns in abdominal organs secondary to increased right atrial pressure have been linked to congestive organ damage, adding another component to the hemodynamic assessment. Integrating POCUS findings with clinical and laboratory data can further elucidate a patient's hemodynamic status. This drives decisions regarding crystalloid administration or, conversely, diuresis or ultrafiltration and allows tailored therapy for individual patients. In this article, we provide an overview of the focused assessment of cardiovascular function and pulmonary and venous congestion using POCUS and review relevant literature.
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Affiliation(s)
- Eduardo R. Argaiz
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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Argaiz ER, Koratala A, Reisinger N. Comprehensive Assessment of Fluid Status by Point-of-Care Ultrasonography. KIDNEY360 2021; 2:1326-1338. [PMID: 35369665 PMCID: PMC8676400 DOI: 10.34067/kid.0006482020] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023]
Abstract
The management of complex fluid and electrolyte disorders is central to the practice of nephrologists. The sensitivity of physical examination alone to determine fluid status is limited, precluding accurate clinical decision making. Point-of-care ultrasonography (POCUS) is emerging as a valuable, noninvasive, bedside diagnostic tool for objective evaluation of physiologic and hemodynamic parameters related to fluid status, tolerance, and responsiveness. Rapid bedside sonographic evaluation can obtain qualitative data on cardiac function and quantitative data on pulmonary congestion. Advanced POCUS, including goal-directed Doppler echocardiography, provides additional quantitative information, including flow velocities and pressures across the cardiac structures. Recently, abnormal Doppler flow patterns in abdominal organs secondary to increased right atrial pressure have been linked to congestive organ damage, adding another component to the hemodynamic assessment. Integrating POCUS findings with clinical and laboratory data can further elucidate a patient's hemodynamic status. This drives decisions regarding crystalloid administration or, conversely, diuresis or ultrafiltration and allows tailored therapy for individual patients. In this article, we provide an overview of the focused assessment of cardiovascular function and pulmonary and venous congestion using POCUS and review relevant literature.
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Affiliation(s)
- Eduardo R. Argaiz
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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50
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Koratala A, Reisinger N. POCUS for Nephrologists: Basic Principles and a General Approach. KIDNEY360 2021; 2:1660-1668. [PMID: 35372985 PMCID: PMC8785785 DOI: 10.34067/kid.0002482021] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/04/2021] [Indexed: 02/04/2023]
Abstract
Point-of-care ultrasonography (POCUS) has evolved as a valuable adjunct to physical examination in the recent past and various medical specialties have embraced it. However, POCUS training and scope of practice remain relatively undefined in nephrology. The utility of diagnostic POCUS beyond kidney and vascular access is under-recognized. Assessment of fluid status is a frequent dilemma faced by nephrologists in day-to-day practice where multiorgan POCUS can enhance the sensitivity of conventional physical examination. POCUS also reduces fragmentation of care, facilitates timely diagnosis, and expedites management. Although the need for further imaging studies is obviated in selected patients, POCUS is not meant to serve as an alternative to consultative imaging. In addition, the utility of POCUS depends on the skills and experience of the operator, which in turn depend on the quality of training. In this review, we discuss the rationale behind nephrologists performing POCUS, discuss patient examples to illustrate the basic principles of focused ultrasonography, and share our experience-based opinion about developing a POCUS training program at the institutional level.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nathaniel Reisinger
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, Pennsylvania
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