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Citoni B, Digilio MC, Capolino R, Gagliardi MG, Campana A, Drago F, Calcagni G. SARS-CoV-2 and Pre-Tamponade Pericardial Effusion. Could Sotos Syndrome Be a Major Risk Factor? Genes (Basel) 2021; 12:genes12111782. [PMID: 34828388 PMCID: PMC8622474 DOI: 10.3390/genes12111782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 12/05/2022] Open
Abstract
Pericarditis with pericardial effusion in SARS CoV-2 infection is a well-known entity in adults. In children and adolescents, only a few cases have been reported. Here, we present here a case of a 15-year-old girl affected by Sotos syndrome with pre-tamponed pericardial effusion occurred during SARS-CoV-2 infection. A possible relation between SARS-CoV-2 pericarditis and genetic syndromes, as a major risk factor for the development of severe inflammation, has been speculated. We emphasize the importance of active surveillance by echocardiograms when SARS-CoV-2 infection occurs in combination with a genetic condition.
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Affiliation(s)
- Barbara Citoni
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (B.C.); (M.G.G.); (F.D.)
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Rome, Italy; (M.C.D.); (R.C.)
| | - Rossella Capolino
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Rome, Italy; (M.C.D.); (R.C.)
| | - Maria Giulia Gagliardi
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (B.C.); (M.G.G.); (F.D.)
| | - Andrea Campana
- Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (B.C.); (M.G.G.); (F.D.)
| | - Giulio Calcagni
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (B.C.); (M.G.G.); (F.D.)
- Correspondence: ; Tel.: +39-0668594096
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Abstract
Uremic pericarditis and pericardial effusion are possible complications among patients with end-stage renal disease. The accumulation of toxic metabolites may contribute to the pathogenesis of uremic pericarditis. Bleeding diathesis in peritoneal dialysis patients raises the risk of hemorrhagic pericardial tamponade, which is a fatal complication of peritoneal dialysis. We report a case of hemorrhagic pericardial tamponade who was nonadherent to peritoneal dialysis with initial presentation of hypotension and syncope. Transthoracic echocardiogram revealed septated, fibrinoid pericardial effusion and right ventricular diastolic compression. A massive bloody pericardial effusion was drained when he underwent the pericardial window procedure. There was a significant improvement both in his clinical condition and in the echocardiogram images after the procedure. Hemorrhagic pericardial tamponade occurs in uremic patients but is rarely seen in those undergoing peritoneal dialysis. Early diagnosis, immediate surgical drainage, and regular follow-up with echocardiography are crucial to achieve better prognoses in future similar clinical scenarios.
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Affiliation(s)
- Yi-Hsin Chou
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ting-Yu Lin
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ann Charis Tan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fan-Yu Chen
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wen-Chung Yu
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chih-Ching Lin
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Araj FG, Sasaki JD. Pulseless Paradoxus: A Unique Sign of Cardiac Tamponade in the Era of Continuous Flow Left Ventricular Assist Devices. Mayo Clin Proc 2020; 95:199-200. [PMID: 31902416 DOI: 10.1016/j.mayocp.2019.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/20/2019] [Accepted: 10/16/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Faris G Araj
- University of Texas Southwestern Medical Center, Dallas
| | - Jun D Sasaki
- University of Texas Southwestern Medical Center, Dallas
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Abstract
Cardiac tamponade is a condition produced by the rapid accumulation of pericardial fluid, which restricts the filling of the heart. Often the forensic pathologist comes across different naturally occurring sudden deaths. Cardiovascular causes are the most common. Death due to cardiac tamponade can cause sudden cardiac death. Acute cardiac tamponade is almost invariably fatal, unless the pressure is relieved by removing the pericardial fluid, either by needle pericardiocentesis or surgical procedures. Cardiac tamponade is more commonly associated with cases of trauma, operative procedures, secondary to myocardial infarction or intra pericardial rupture of great vessels. Previous literature showed an association of cardiac tamponade with many other pathological conditions such as malignancy, central venous catheterisation, open heart surgery, dissecting aneurysm of the aorta, myocardial abscess, infective endocarditis, etc. We report a series of three cases where cardiac tamponade was given as the cause of death on autopsy secondary to post-myocardial infarction wall rupture.
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Affiliation(s)
- Nagendra Singh Sonwani
- Department of Forensic Medicine, University College of Medical Sciences & GTB Hospital, Delhi, India
| | - Navneet Ateriya
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India
| | - Arvind Kumar
- Department of Forensic Medicine, University College of Medical Sciences & GTB Hospital, Delhi, India
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Ang KP, Nordin RB, Lee SCY, Lee CY, Lu HT. Diagnostic value of electrocardiogram in cardiac tamponade. Med J Malaysia 2019; 74:51-56. [PMID: 30846663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION We aim to study the diagnostic value of electrocardiogram (ECG) in cardiac tamponade. METHODS This study was a single centre, retrospective casecontrol study. We recruited 42 patients diagnosed with cardiac tamponade of various aetiologies confirmed by transthoracic echocardiography and 100 controls between January 2011 and December 2015. The ECG criteria of cardiac tamponade we adopted was as follows: 1) Low QRS voltage in a) the limb leads alone, b) in the precordial leads alone or, c) in all leads, 2) PR segment depression, 3) Electrical alternans, and 4) Sinus tachycardia. RESULTS Malignancy was the most common causes of cardiac tamponade, the two groups were of similar proportion of gender and ethnicity. We calculated the sensitivity (SN), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of each ECG criteria. Among the ECG abnormalities, we noted the SN of 'low voltage in all chest leads' (69%), 'low voltage in all limb leads' (67%) and 'sinus tachycardia' (69%) were higher as compared to 'PR depression' (12%) and 'electrical alternan' (5%). On the other hand, 'low voltage in all chest leads' (98%), 'low voltage in all leads' (99%), 'PR depression' (100%) and 'electrical alternans' (100%) has highest SP. CONCLUSION Our study reaffirmed the findings of previous studies that electrocardiography cannot be used as a screening tool for diagnosing cardiac tamponade due to its low sensitivity. However, with clinical correlation, electrocardiography is a valuable adjuvant test to 'rule in' cardiac tamponade because of its high specificity.
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Affiliation(s)
- K P Ang
- Sultanah Aminah Hospital, Department of Cardiology, Johor Bahru, Johor, Malaysia.
| | - R B Nordin
- Monash University Malaysia, Jeffrey Cheah School of Medicine and Health Sciences, Johor Bahru, Johor, Malaysia
| | - S C Y Lee
- Sultanah Aminah Hospital, Department of Cardiology, Johor Bahru, Johor, Malaysia
| | - C Y Lee
- Sultanah Aminah Hospital, Department of Cardiology, Johor Bahru, Johor, Malaysia
| | - H T Lu
- Sultanah Aminah Hospital, Department of Cardiology, Johor Bahru, Johor, Malaysia
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Singh H, Pannu AK, Suri V, Bhalla A, Kumari S. Pericardial effusion and electrical alternans. QJM 2019; 112:135-136. [PMID: 30165695 DOI: 10.1093/qjmed/hcy191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh, India
| | - A K Pannu
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh, India
| | - V Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh, India
| | - A Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh, India
| | - S Kumari
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh, India
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Wu K, Huang Z, Zhong Z, Liao H, Zhou Y, Luo B, Zhang B. Predictors, treatment, and long-term outcomes of coronary perforation during retrograde percutaneous coronary intervention via epicardial collaterals for recanalization of chronic coronary total occlusion. Catheter Cardiovasc Interv 2019; 93:800-809. [PMID: 30690863 DOI: 10.1002/ccd.28093] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/03/2019] [Accepted: 01/07/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate predictors, treatment, and long-term outcomes associated with coronary perforation (CP) in patients who underwent retrograde percutaneous coronary intervention (PCI) through epicardial collaterals for chronic total occlusion (CTO). BACKGROUND Data regarding CP during retrograde PCI through epicardial collaterals for CTO are scarce. METHODS We included 155 patients who underwent retrograde CTO PCI through epicardial collaterals at Guangdong Cardiovascular Institute from August 2011 to December 2017. The median follow-up was 2.5 years. Major adverse cardiac events (MACEs) were analyzed using the Kaplan-Meier method, and independent predictors of long-term MACE were determined using a multivariable Cox model. RESULTS CP occurred in 24 (15.5%) patients, with the frequency of Ellis classes 1 or 2 and 3 being 41.7% and 58.3%, respectively. Seven (4.5%) patients had tamponade, which was effectively managed using coil embolization and pericardiocentesis. Renal dysfunction (odds ratio [OR]: 5.27; 95% confidence interval [CI]: 1.47-18.88; P = 0.011), right coronary artery (RCA) CTO (OR: 4.34; 95% CI: 1.29-14.63; P = 0.018), and Epi-CTO score ≥ 2 (OR: 3.27; 95% CI: 1.12-9.58; P = 0.030) were independent predictors of CP. At the 7-year follow-up, 17 patients had MACE. Multivariable analysis revealed that CP was not associated with worse long-term clinical outcomes (hazard ratio: 1.55; 95% CI: 0.45-5.32, P = 0.484). CONCLUSIONS Retrograde CTO PCI through epicardial collaterals is at increased risk of CP, which is associated with renal dysfunction, RCA CTO, and Epi-CTO score ≥ 2. Prompt and proper management of CP is important. CP is not significantly associated with adverse clinical outcomes.
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Affiliation(s)
- Kaize Wu
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Zehan Huang
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Zhian Zhong
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Hongtao Liao
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Yi Zhou
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Bingzheng Luo
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Bin Zhang
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
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Morgan R, Murdock R, Leng P. A Man in His 50s Presenting With Rapid-Onset Dyspnea and Obstructive Shock. Chest 2018; 154:e153-e156. [PMID: 30526980 DOI: 10.1016/j.chest.2018.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- Robert Morgan
- Legacy Good Samaritan Medical Center, Graduate Medical Education - Internal Medicine, Portland, OR.
| | - Robert Murdock
- Legacy Good Samaritan Medical Center, Graduate Medical Education - Internal Medicine, Portland, OR
| | - Poh Leng
- Legacy Good Samaritan Medical Center, Graduate Medical Education - Internal Medicine, Portland, OR
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Abstract
Subacute tamponade is a challenging diagnosis requiring careful consideration of both clinical and imaging data. We aimed at exploring the association of initial blood pressure with markers of pericardial effusion severity in patients with moderate and large pericardial effusion. We conducted a retrospective, single-center study in 102 well-phenotyped patients with moderate and large pericardial effusion. The presenting systolic and diastolic blood pressure recordings were divided into tertiles to examine the association between the blood pressure and the different established markers of pericardial effusion severity. On presentation, 42% of patients had systolic blood pressure exceeding 130 mm Hg, and only 5% of patients had systolic blood pressure <90 mm Hg. Patients in the lowest blood pressure tertiles did not differ significantly from patients in the upper tertiles in terms of clinical, etiologic, or echocardiographic characteristics. Although patients who underwent pericardial drainage had higher presenting heart rates, no significant differences were seen in the blood pressure recordings, either systolic or diastolic (mean 125 mm Hg vs 130 mm Hg, p = 0.36 and 76 vs 75 mm Hg, p = 0.82, respectively). In conclusion, systolic and diastolic blood pressure recordings upon initial presentation do not demonstrate a significant association with markers of effusion severity or the need for drainage in patients with moderate and large pericardial effusion.
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Affiliation(s)
- Yash Patel
- Mount Sinai Heart, Mount Sinai St Luke's Hospital, Icahn School of Medicine, New York, New York
| | - Vikram Agarwal
- Division of Cardiology, St. Luke's Hospital, Chesterfield, Missouri
| | - Edgar Argulian
- Mount Sinai Heart, Mount Sinai St Luke's Hospital, Icahn School of Medicine, New York, New York.
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10
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Shyy W, Knight RS, Kornblith A, Teismann NA. Point-of-Care Diagnosis of Cardiac Tamponade Identified by the Flow Velocity Paradoxus. J Ultrasound Med 2017; 36:2197-2201. [PMID: 28503752 DOI: 10.1002/jum.14251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/02/2017] [Indexed: 06/07/2023]
Abstract
The presentation of cardiac tamponade is a spectrum from occult to extreme. The clinical history, physical exam, electrocardiogram, and radiographic findings of tamponade have poor sensitivities and even worse specificities. We use a clinical scenario to demonstrate how point-of-care cardiac ultrasound can diagnose impending cardiac tamponade in a clinically stable patient. The ultrasound finding we recommend is the flow velocity paradoxus, in which respiratory variation causes significant changes in transvalvular inflow velocities, which are exaggerated when tamponade is present. The management of a pericardial effusion depends on its physiologic effect, and point-of-care ultrasound directly measures that effect and expedites patient care.
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Affiliation(s)
- William Shyy
- Department of Emergency Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Roneesha S Knight
- Department of Emergency Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Aaron Kornblith
- Department of Emergency Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Nathan A Teismann
- Department of Emergency Medicine, San Francisco Medical Center, University of California, San Francisco, California, USA
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DeFilippis EM, Vaidya A, Ramani S, French C, Kirshenbaum JM. Under Pressure. N Engl J Med 2017; 376:e23. [PMID: 28355512 DOI: 10.1056/nejmimc1609719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Affiliation(s)
- Roberta Kaplow
- Roberta Kaplow is an oncology clinical nurse specialist at Emory University Hospital in Atlanta, Ga., and Karen Iyere is a clinical nurse at the Veterans Administration Medical Center in Decatur, Ga
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Mohanan Nair KK, Gopalakrishnan A, Ganapathi S, Harikrishnan S, Valaparambil A, Tharakan J. Arterial Discordance in Cardiac Tamponade. J Invasive Cardiol 2016; 28:E124-E125. [PMID: 27705896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ventricular interdependence is a salient hemodynamic feature of cardiac tamponade that manifests as discordance between the left and right ventricles in filling and ejection on hemodynamic assessment. Ventricular interdependence can manifest as arterial discordance at the level of the great arteries.
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Affiliation(s)
| | - Arun Gopalakrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India - 695011.
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Habashy AG, Mittal A, Ravichandran N, Cherian G. The Electrocardiogram in Large Pericardial Effusion: The Forgotten “P” Wave and the Influence of Tamponade, Size, Etiology, and Pericardial Thickness on QRS Voltage. Angiology 2016; 55:303-7. [PMID: 15156264 DOI: 10.1177/000331970405500310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are varying reports on the electrocardiogram in pericardial effusions. Some correlate low QRS voltage with tamponade and the size of the effusion while others do not. Low voltage also appears to vary with the etiology. There are no reports on the influence of pericardial thickness or changes in the P voltage. The authors studied 43 patients with large effusions of whom 26 had tuberculosis and the remaining had viral/idiopathic etiology. Pericardial thickness was measured at chest computed tomography. They found no correlation between the low QRS voltage and tamponade, size of the effusion, etiology, or pericardial thickness. Low voltage of the P wave and T-wave changes were more frequent than low QRS voltage.
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Affiliation(s)
- Atef G Habashy
- Cardiology Department, Chest Hospital, Ministry of Health, Safat, Kuwait
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Vandeloo B, Dymarkowski S, Budts W. Unexpected perforation leading to life-threatening cardiac tamponade six years after patent foramen ovale closure with an intrasept device. Acta Cardiol 2016; 71:247-8. [PMID: 27090049 DOI: 10.2143/ac.71.2.3141857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Crystal GJ, Metwally AA, Salem MR. Isoflurane preserves central nervous system blood flow during intraoperative cardiac tamponade in dogs. Can J Anaesth 2014; 51:1011-7. [PMID: 15574553 DOI: 10.1007/bf03018490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The present study tested the hypothesis that the anesthetic technique will influence the changes in regional blood flow (RBF) during intraoperative cardiac tamponade. METHODS Twenty-four dogs were divided into three equal groups: Group I, anesthesia was maintained with ketamine (25 mg.kg(-1).hr(-1)); Group II, with fentanyl and midazolam (F-M; 10 mug.kg(-1).hr(-1) and 0.5 mg.kg(-1).hr(-1), respectively); Group III with 1 minimum alveolar concentration (MAC; 1.4%) isoflurane. Radioactive microspheres were used to measure RBF in myocardium, brain, spinal cord, abdominal viscera, skeletal muscle and skin. Cardiac output (CO) was measured by thermodilution and arterial pressure with a catheter situated in the thoracic aorta. Catheters were introduced into the pericardial cavity to infuse isotonic saline and to measure intrapericardial pressure (IPP). Measurements were obtained under control conditions and during tamponade, as defined by an increase in IPP sufficient to reduce mean arterial pressure by 40%. RESULTS Tamponade caused decreases in CO and RBF that were comparable under the three anesthetics, except that RBF in subcortical regions of the brain and in the spinal cord were maintained under isoflurane but decreased under ketamine or F-M. CONCLUSIONS In dogs, intraoperative cardiac tamponade caused comparable changes in RBF under the different anesthetic techniques except that autoregulation was effective in maintaining RBF within the central nervous system only under isoflurane anesthesia. Our findings provide no compelling reason to recommend one anesthetic over the others for maintenance of anesthesia in situations with increased risk for intraoperative cardiac tamponade. However, they cannot be extrapolated to anesthesia induction in the presence of cardiac tamponade.
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Affiliation(s)
- George J Crystal
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Chicago, Illinois 60657-5193, USA.
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Danielian SN, Abakumov MM, Tarabrin EA, Radchenko IA, Rabadanov KM, Migunova EV. [Rupture of myocardium with cardiac tamponade in nonpenetrating wound of the breast from traumatic weapon]. Vestn Khir Im I I Grek 2014; 173:75-76. [PMID: 25055540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Donahoe L, Ouzounian M, MacDonald S, Field S. Delayed pericardial effusion and cardiac tamponade following penetrating chest trauma. CAN J EMERG MED 2013; 15:186-189. [PMID: 23663469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We present the case of a 20-year-old man who was stabbed in the left chest and was diagnosed with a large pericardial effusion by focused emergency department (ED) ultrasonography. After placement of a left chest tube for presumed tension pneumothorax, the pericardial effusion had resolved. The patient's postinjury course was complicated by pericarditis and recurrent tamponade, which required repeated pericardiocentesis for management. This case illustrates the role of focused ED ultrasonography for diagnosis of pericardial effusion in penetrating trauma and the potential for delayed pericardial effusion and tamponade in such patients. Although the pathophysiology of delayed pericardial effusion is unclear, autoimmune postpericardiotomy syndrome has been proposed as the cause of this rare condition. Our case underscores the importance of close monitoring of patients with known or suspected pericardial injuries due to their potential for the development of life-threatening complications.
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Abusaid GH, Khalife WI. Reduced coronary blood flow in cardiac tamponade: mystery solved. J Invasive Cardiol 2012; 24:E328-E329. [PMID: 23220996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 67-year-old male presented with several week history of progressive shortness of breath, lower extremity edema, and distended jugular veins. Transthoracic echocardiography showed moderate pericardial effusion with thickened visceral pericardium and septal bounce but no chamber collapse. Right and left cardiac catheterization showed discordance of the right and left ventricular systolic pressures during respiration and severely reduced cardiac output. There was near equalization of diastolic pressures in all four chambers suggestive of effusive-constrictive pericarditis with cardiac tamponade physiology. Simultaneous coronary angiography showed remarkably reduced coronary Thrombolysis in Myocardial Infarction (TIMI) flow (TIMI grade 2 flow). Coronary blood flow was restored to normal after pericardial drainage on repeat coronary angiography. This is the first report of reduced coronary blood flow on coronary angiography in patients with effusive-constrictive pericarditis and cardiac tamponade. Our finding complements the work of previous investigators as we show that elevated intrapericardial pressures in cardiac tamponade can reduce coronary blood flow. This is likely related to extrinsic epicardial coronary vessel compression and reduced perfusion pressures, which can lead to myocardial ischemia and eventually cardiogenic shock.
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Affiliation(s)
- Ghassan H Abusaid
- Department of Internal Medicine-Cardiology Division, University of Texas Medical Branch, JSA 5.106G, Galveston, TX 77555-0553, USA.
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Potter BJ, Quan VH, Masson JB. The fluoroscopic swinging heart: a rare sight for the modern interventionalist. Can J Cardiol 2012; 29:519.e5-6. [PMID: 23146563 DOI: 10.1016/j.cjca.2012.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 08/07/2012] [Accepted: 08/14/2012] [Indexed: 11/19/2022] Open
Abstract
Herein, we present the case of a 49-year-old woman who presented to a peripheral hospital with a 4-day history of progressive shortness of breath. Following a clinical diagnosis of heart failure and slightly elevated cardiac troponins on initial blood work, the patient was referred for same-day diagnostic coronary angiography, which revealed normal coronary arteries but the surprising finding of a fluoroscopic swinging heart due to a massive pericardial effusion. The patient promptly improved after emergent pericardiocentesis. Fluoroscopic clues to the diagnosis of pericardial effusion are reviewed, with accompanying illustrative video and hemodynamic tracings.
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Affiliation(s)
- Brian J Potter
- Centre de Recherche et Centre Cardiovasculaire du Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada.
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22
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Tiwari S, LeJemtel T, Finn M. Role of ventricular interdependence as an early echocardiographic sign of cardiac surgical postoperative pericardial tamponade. J La State Med Soc 2012; 164:336-342. [PMID: 23431677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Pericardial effusions are common in postoperative cardiac surgical patients. Cardiac tamponade occurs relatively infrequently postoperatively and may mimick other conditions, such as heart failure, renal failure, and pulmonary emboli. Echocardiographic examination is frequently hampered in the immediate postoperative period due to suboptimal imaging. The current case series focuses on the echocardiographic findings in tamponade in the postoperative patient with emphasis on ventricular interdependence as an early sign of impending tamponade.
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Low TT, Tan VSR, Teo SG, Poh KK. ECGs with small QRS voltages. Singapore Med J 2012; 53:299-304. [PMID: 22584968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The causes of low voltage complexes on the electrocardiogram (ECG) are variable; however, they are not commonly discussed. An ECG with small QRS amplitudes may initially look unremarkable to the unwary, but some of the underlying conditions may be critical. Although imperfect, the ECG is still a useful, noninvasive and readily available tool for the screening of these underlying conditions. We present two cases with low voltage complexes in the ECG. The first case highlights how the findings on ECG and subsequent echocardiogram led to the diagnosis of a rare case of cardiac amyloidosis. In the second case, a screening electrocardiogram alerted the physicians to a life-threatening condition, that of a large pericardial effusion with cardiac tamponade.
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Affiliation(s)
- Ting Ting Low
- Cardiac Department, National University Heart Centre, National University of Singapore, Singapore
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Keene D, Gopinath A, Watson W, Maart C, Bokhari A. Signs of shock and raised jugular venous pressure. BMJ 2012; 344:e2643. [PMID: 22522817 DOI: 10.1136/bmj.e2643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Daniel Keene
- Cardiology Department, Bedford Hospital, Bedford MK42 9DJ, UK.
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25
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Baruah DK, Lakshmi A, Chandrashekaran V. Recurrent cardiac tamponade following unusual micro leak after successful closure of the primary leak. J Invasive Cardiol 2012; 24:E47-E49. [PMID: 22388314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Although uncommon, coronary artery perforation is one of the most dreadful complications of percutaneous coronary intervention, which requires prompt, aggressive, and effective management. Perforations induced by coronary guidewires are usually located in the distal part of a coronary artery and commonly managed with embolization. This is an unusual case report of guidewire-induced coronary perforation with recurrent cardiac tamponade, which was managed successfully by coil embolization of both ipsilateral and contralateral coronary arteries via transradial approach.
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26
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Abdelsalam M, Moritz TA, Snyder JA, Cheriyath P, Spizzieri CL. Paradoxical hemodynamic instability complicating pericardial window surgery for cardiac tamponade in a cancer patient. Tex Heart Inst J 2012; 39:711-713. [PMID: 23109775 PMCID: PMC3461695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Paradoxical hemodynamic instability is defined as unexpected hemodynamic compromise that develops in a patient after pericardial fluid drainage. The overall incidence of the condition is about 5%, and it has a high in-hospital mortality rate. The condition has been reported to occur regardless of the approach that is used to drain the fluid or the underlying cause of the disease. The pathophysiology of paradoxical hemodynamic instability and the appropriate intervention are not very clear, and further studies are needed to identify appropriate preventive measures.We report a rare manifestation of paradoxical hemodynamic instability in a 65-year-old woman who had a history of stage IV lung cancer. She presented with a one-week history of pleuritic chest pain and shortness of breath on exertion. Echocardiography revealed a large circumferential pericardial effusion with right atrial and ventricular collapse during diastole, suggesting a compressive effect of the pericardial fluid; however, left ventricular systolic function was well preserved. The patient underwent the scheduled creation of a subxiphoid pericardial window. Immediately after the pericardial fluid was evacuated, her heart began to beat more vigorously, but this was abruptly followed by an episode of asystole. Pacing and medical therapy were unsuccessful in preventing repeated episodes of asystole, and the patient died.To our knowledge, this is the 2nd report of unexpected asystole after the creation of a subxiphoid pericardial window, and it is the first report of a takotsubo-like contractile pattern associated with paradoxical hemodynamic instability.
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MESH Headings
- Aged
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/therapy
- Carcinoma, Non-Small-Cell Lung/complications
- Carcinoma, Non-Small-Cell Lung/secondary
- Carcinoma, Non-Small-Cell Lung/therapy
- Cardiac Tamponade/diagnosis
- Cardiac Tamponade/etiology
- Cardiac Tamponade/physiopathology
- Cardiac Tamponade/surgery
- Echocardiography
- Fatal Outcome
- Female
- Heart Arrest/etiology
- Heart Arrest/physiopathology
- Heart Rate
- Hemodynamics
- Humans
- Lung Neoplasms/complications
- Lung Neoplasms/pathology
- Lung Neoplasms/therapy
- Neoplasm Staging
- Pericardial Window Techniques/adverse effects
- Pleural Effusion, Malignant/diagnosis
- Pleural Effusion, Malignant/etiology
- Pleural Effusion, Malignant/physiopathology
- Pleural Effusion, Malignant/surgery
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Affiliation(s)
- Murad Abdelsalam
- Department of Internal Medicine, Pinnacle Health/Harrisburg Hospital, Harrisburg, Pennsylvania 17101, USA.
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27
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Kirti R, Karadi R. Cardiac tamponade: atypical presentations after cardiac surgery. Acute Med 2012; 11:93-96. [PMID: 22860267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We present two cases of cardiac tamponade presenting in the aftermath of cardiac surgery. We have briefly discussed the aetiology, presentation, diagnosis and management of the condition with emphasis on its atypical presentation in postoperative patients. A high index of suspicion and early access to echocardiography is necessary for prompt recognition and treatment of this life threatening emergency.
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Affiliation(s)
- Ravi Kirti
- Dewsbury and District Hospital Halifax Road, Dewsbury WF13 4HS, UK
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29
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Sisson CA. Electrical alternans: an echocardiographic visual reference. Acad Emerg Med 2010; 17:e48-9. [PMID: 20491677 DOI: 10.1111/j.1553-2712.2010.00769.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Craig A Sisson
- Department of Emergency Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
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30
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Sadeghi N, Rankey D, Bledsoe BE. A fluid situation: patient suffers from uncommon cardiac tamponade. JEMS 2010; 35:36-40. [PMID: 20569862 DOI: 10.1016/s0197-2510(10)70144-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Nick Sadeghi
- University Medical Center of Southern Nevada, Nevada, USA
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31
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Ariyarajah V, Hussain F, McGregor R, Raabe M, Menkis A, Jassal DS. Progression of low-pressure to acute classic cardiac tamponade-a diagnostic dilemma in the setting of spontaneous left ventricular rupture. Am Heart Hosp J 2010; 8:E133-E135. [PMID: 21928183 DOI: 10.15420/ahhj.2010.8.2.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cardiac tamponade (CT) is a pathophysiologic continuum where hemodynamic embarrassment occurs as a result of progressive, decreased venous return that impairs diastolic ventricular filling, which in turn, when uncorrected, severely compromises cardiac output. While CT is classically associated with high intrapericardial pressures due to rapidly accumulating large pericardial effusions, low-pressure CT is a recognized entity in which a comparatively low intrapericardial pressure could result in cardiac chamber compression and subsequent cardiovascular collapse. In this article, we highlight a previously unreported scenario of rapidly re-accumulating, acute CT in the setting of left ventricular rupture in a patient who had presumably presented with low-pressure CT due to hemoperiardium.
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Affiliation(s)
- Vignendra Ariyarajah
- Division Cardiology, Department of Cardiac Sciences, St Boniface General Hospital, Winnipeg, Manitoba, Canada
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32
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Affiliation(s)
- Amrut V Ambardekar
- Division of Cardiology, Denver Health Medical Center and University of Colorado, Denver, CO, USA
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33
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Stöllberger C, Huber JO, Enzelsberger B, Finsterer J. Fatal outcome of epileptic seizure-induced takotsubo syndrome with left ventricular rupture. Eur J Neurol 2009; 16:e116-7. [PMID: 19475750 DOI: 10.1111/j.1468-1331.2009.02619.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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34
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Brubakk O, Kalager T, Foling M, Solberg CO, Overa O. Systolic time intervals in cardiac tamponade. Acta Med Scand 2009; 200:465-7. [PMID: 1015355 DOI: 10.1111/j.0954-6820.1976.tb08266.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Systolic time intervals (STI) have been measured in three patients with cardiac tamponade. The left ventricular ejection time (LVET), the preejection period (PEP) and the ratio PEP/LVET deviated significantly from the normal values. All three parameters improved immediately after pericardiocentesis and aspiration. The total electromechanical systole changed to only a minor degree. Measurement of STI may be a valuable tool in the diagnosis and treatment of cardiac tamponade.
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35
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Hagel KJ. Echocardiographic findings in cardiac tamponade. Acta Med Scand Suppl 2009; 627:217-23. [PMID: 286514 DOI: 10.1111/j.0954-6820.1979.tb01107.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
A case of systemic hypotension with volume depletion not responding to intravenous fluids was found to have features of cardiac tamponade on two-dimensional (2-D) echocardiography. Intracardiac pressures were normal on cardiac catheterization. An interesting observation was the presence of left ventricular (LV) collapse on 2-D echocardiography. To the authors' best knowledge, such a case of low pressure cardiac tamponade with LV collapse has not been reported earlier.
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Affiliation(s)
- S K Dwivedi
- Department of Cardiology, King George Medical College, Lucknow, U.P., India
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37
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Abstract
Rupture of the myocardial free wall is an infrequent complication of acute myocardial infarction. Unless it occurs in a space confined by pericardial adhesions, only surgical emergency repair of ruptured myocardium can prevent death. In this paper we report the case of an 81-year-old woman who was admitted to the emergency room with cardiac tamponade, resulting from inferolateral acute myocardial infarction and a subsequent rupture of the right ventricular free wall, with the formation of pericardial thrombus and effusion. The patient refused to undergo any surgical or invasive intervention, and therefore she was only treated conservatively. Nevertheless, her condition improved dramatically, as her blood pressure increased and echocardiography abnormalities almost disappeared. Follow-up echocardiography 7 months post discharge was unremarkable. We believe that this rare case emphasizes that in special circumstances, such as creation of a thrombus that prevents more blood from extravasating, free-wall rupture without surgical repair is compatible with long-term survival.
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Affiliation(s)
- Y Sherer
- Department of Medicine B, Sheba Medical Center, Tel-Hashomer, Israel
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Aneman A, Treggiari MM, Burgener D, Laesser M, Strasser S, Hadengue A. Tezosentan normalizes hepatomesenteric perfusion in a porcine model of cardiac tamponade. Acta Anaesthesiol Scand 2009; 53:203-9. [PMID: 19094177 DOI: 10.1111/j.1399-6576.2008.01834.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND To investigate endothelin-1 (ET-1)-dependent hepatic and mesenteric vasoconstriction, and oxygen and lactate fluxes in an acute, fixed low cardiac output (CO) state. METHODS Sixteen anesthetized, mechanically ventilated pigs were studied. Cardiac tamponade was established to reduce portal venous blood flow (Q(PV)) to 2/3 of the baseline value. CO, hepatic artery blood flow (Q(HA)), Q(PV), hepatic laser-Doppler flow (LDF), hepatic venous and portal pressure, and hepatic and mesenteric oxygen and lactate fluxes were measured. Hepatic arterial (R(HA)), portal (R(HP)) and mesenteric (R(mes)) vascular resistances were calculated. The combined ET(A)-ET(B) receptor antagonist tezosentan (RO 61-0612) or normal saline vehicle was infused in the low CO state. Measurements were made at baseline, after 30, 60, 90 min of tamponade, and 30, 60, 90 min following the infusion of tesozentan at 1 mg/kg/h. RESULTS Tamponade decreased CO, Q(PV), Q(HA), LDF, hepatic and mesenteric oxygen delivery, while hepatic and mesenteric oxygen extraction and lactate release increased. R(HA), R(HP) and R(mes) all increased. Ninety minutes after tesozentan, Q(PV), LDF and hepatic and mesenteric oxygen delivery and extraction increased approaching baseline values, but no effect was seen on CO or Q(HA). Hepatic and mesenteric handling of lactate converted to extraction. R(HA), R(HP) and R(mes) returned to baseline values. No changes were observed in these variables among control animals not receiving tesozentan. CONCLUSION In a porcine model of acute splanchnic hypoperfusion, unselective ET-1 blockade restored hepatomesenteric perfusion and reversed lactate metabolism. These observations might be relevant when considering liver protection in low CO states.
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Affiliation(s)
- A Aneman
- Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Göteborg, Sweden.
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39
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Roussos C, Aubier M. Neural drive and electromechanical alterations in the fatiguing diaphragm. Ciba Found Symp 2008; 82:213-33. [PMID: 6913472 DOI: 10.1002/9780470715420.ch13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
It is suggested that respiratory failure in the compromised circulation might occur as a result of respiratory muscle fatigue in the presence of adequate neural drive and muscle excitation. As the cardiac output decreases acidosis develops and ventilation increases, resulting in an increase in the work of breathing, which requires the delivery of large supplies of energy. As these demands cannot be met by the energy supply, because of low cardiac output, the diaphragm fails as a force generator and respiratory failure ensues. Diaphragmatic fatigue may occur in normal subjects if the pressure developed with each breath is greater than 40% of the maximum transdiaphragmatic pressure and hypoxia predisposes the diaphragm to fatigue. Diaphragmatic fatigue, as in other skeletal muscles, might be located either at the neuromuscular junction or distal to it and can be detected either by phrenic stimulation or by frequency analysis of the myoelectric signal. Phrenic stimulation shows that after fatigue the diaphragm develops less force at any frequency of stimulation, but the loss of force at low frequencies persists for a longer period than at high frequencies. Frequency analysis of the electromyogram reveals that the power spectrum shifts to lower frequencies. This shift occurs long before the diaphragm fails as a force generator.
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Qureshi AC, Lindsay AC, Mensah K, Jackson JE, Farrimond JG, Mittal TK, Kelion A, Khaghani A, Mitchell AG. Tamponade and the rule of tens. Lancet 2008; 371:1810. [PMID: 18502306 DOI: 10.1016/s0140-6736(08)60769-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ayesha C Qureshi
- Department of Cardiology and Cardiothoracic Surgery, Harefield Hospital, Middlesex, UK.
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Merino C. [Comment on the Image of the month "Pulsus paradoxus and the pulse oximetry waveform"]. Rev Esp Anestesiol Reanim 2008; 55:260. [PMID: 18543517 DOI: 10.1016/s0034-9356(08)70565-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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42
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Christie SL, Sawatzky JAV. Acute cardiac tamponade: anticipate the complication. Dynamics 2008; 19:13-17. [PMID: 19177814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Acute cardiac tamponade (ACT) is a serious complication following cardiac surgery. ACT occurs as a result of post-operative bleeding in the first five to seven days following the operative procedure. Although the incidence of ACT is relatively low, the consequences include cardiac compromise and even death. This article includes a review of the pathophysiology, assessment, prevention, signs, diagnosis, and management strategies for patients who develop ACT The knowledge gleaned from this article will enable the critical care nurse to anticipate and prevent this life-threatening complication and, thus, optimize outcomes for this complex surgical population.
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Sanda S, Newfield RS. A child with pericardial effusion and cardiac tamponade due to previously unrecognized hypothyroidism. J Natl Med Assoc 2007; 99:1411-1413. [PMID: 18229779 PMCID: PMC2575930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We present a 12-year-old Hispanic girl without overt symptoms of hypothyroidism who presented with early cardiac tamponade from pericardial effusion due to previously unrecognized hypothyroidism. Pediatric patients with unexplained pericardial effusions should be screened for hypothyroidism and should be followed closely for the development of tamponade if found to have hypothyroidism.
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Affiliation(s)
- Srinath Sanda
- Division of Pediatric Endocrinology, University of Washington School of Medicine, Seattle, WA, USA.
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Saitoh H, Eguchi S, Maruyama Y, Kansaku R, Takae H, Sagawa N. [Preoperative pulseless electrical activity of acute type A aortic dissection; report of a case]. Kyobu Geka 2007; 60:1192-1195. [PMID: 18078089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
An 80-year-old man with acute type A aortic dissection, who was preoperatively observed in the intensive care unit, suddenly became unresponsive. The patient was immediately intubated, but a pulse check was delayed because the cardiac monitor seemingly showed a normal sinus rhythm. Bedside echocardiography, while continuing cardiopulmonary resuscitation, revealed massive pericardial effusion. It indicated the patient's cardiac arrest was pulseless electrical activity (PEA) due to cardiac tamponade. After pericardiocentesis, a perfusion rhythm was restored with palpable distal pulse. He successfully underwent a prosthetic graft replacement of the ascending aorta and was discharged after physical rehabilitation.
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Affiliation(s)
- H Saitoh
- Department of Cardiovascular Surgery, Niigata Kobari Hospital, Niigata, Japan
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Abstract
This case report describes the first reported successful UK pre-hospital thoracotomy performed outside the London HEMS system. Continuous ECG monitoring during the procedure has allowed presentation of sequential ECGs recorded during the procedure.
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Affiliation(s)
- Charles D Deakin
- South Central Ambulance Service NHS Trust (Hampshire Division), Highcroft, Romsey Road, Winchester SO22 5DH, UK.
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46
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Restrepo CS, Lemos DF, Lemos JA, Velasquez E, Diethelm L, Ovella TA, Martinez S, Carrillo J, Moncada R, Klein JS. Imaging Findings in Cardiac Tamponade with Emphasis on CT. Radiographics 2007; 27:1595-610. [PMID: 18025505 DOI: 10.1148/rg.276065002] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- C Santiago Restrepo
- Department of Radiology, University of Texas Health Sciences Center, San Antonio, USA
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47
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Komiyama N. [Cardiac tamponade]. Nihon Rinsho 2007; Suppl 5 Pt 2:399-403. [PMID: 17953026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Nobuyuki Komiyama
- Division of Cardiology, International Medical Center, Saitama Medical University
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Otsuka H, Morita S, Iizuka S, Uemura S, Nakagawa Y, Yamamoto I, Inokuchi S. A case of traumatic cardiac tamponade showing sudden spontaneous disappearance of the pericardial fluid. Tokai J Exp Clin Med 2007; 32:90-94. [PMID: 21318944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 07/06/2007] [Indexed: 05/30/2023]
Abstract
Traumatic cardiac tamponade must be treated by pericardial drainage as soon as possible. We recently encountered a rare case of traumatic cardiac tamponade in which the pericardial fluid disappeared spontaneously immediately before the planned drainage. This case is reported in this paper. The patient was a 22-year-old male who was transported to our hospital after he sustained injuries in a traffic accident. The patient was diagnosed to have a facial bone fracture, bilateral lung contusions, myocardial contusion (suspected), injury to the spinal cord at the L3-L4 level, injury to the left kidney and pelvic fracture. After TAE was performed to deal with the bleeding from the injured pelvis, the patient was immediately hospitalized. About 6 hours after the injury, pericardial fluid accumulation began to be noted, and about 18 hours after the injury, the patient went into shock, responding poorly to fluid resuscitation and treatment with pressor agents. At this time, a diagnosis of cardiac tamponade was made and emergency operation was arranged for. However, just before this could be executed, the patient's blood pressure showed a sharp rise, accompanied by disappearance of the pericardial fluid. He continued to show steady improvement and could eventually be discharged from the hospital.
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Affiliation(s)
- Hiroyuki Otsuka
- Department of Emergency and Critical Care Medicine, Tokai University Hospital.
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Abstract
The reported sensitivity of the echocardiographic finding of right atrial collapse for the diagnosis of tamponade ranges from 50% to100%; specificities have ranged from 33% to 100%. Its sensitivity in identifying right ventricular collapse ranges from 48% to 100% whereas the specificity ranges from 72% to 100%. Collapse of either the right atrium or right ventricle is not reliable except in cases where the risk of tamponade is high, consistent with Bayes' theorem. If the patient has hypotension, tachycardia, dyspnea, increased venous pressure, and a pericardial effusion, the diagnosis of tamponade will likely be sustained. To explain pulsus paradoxus, most echocardiographic reports have invoked Dornhorst's theory that inspiratory filling of the right ventricle actively collapses the left ventricle by successfully competing for a fixed total pericardial space ("ventricular interdependence"). However, the pericardial space is not fixed in tamponade but increases with inspiration, and the right heart is much more likely to collapse than the left, given their relative thickness. Pulsus paradoxus depends on the inspiratory surge to the right heart, exaggerated by the small stroke volume of both ventricles induced by tamponade, and vascular coupling between the pulmonary and systemic beds, with a transit time of one to two heart beats.
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Affiliation(s)
- W G Guntheroth
- Department of Pediatrics (Cardiology), University of Washington School of Medicine, Box 356320, Seattle, WA 98185, USA
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50
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