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Il'Giovine ZJ, Gage A, Higgins A. Cardiac Tamponade and Pericardiocentesis: Recognition, Standard Techniques, and Modern Advancements. Cardiol Clin 2024; 42:159-164. [PMID: 38631787 DOI: 10.1016/j.ccl.2024.02.004] [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] [Indexed: 04/19/2024]
Abstract
Pericardiocentesis is an important diagnostic and therapeutic procedure. In the setting of cardiac tamponade, pericardiocentesis can rapidly improve hemodynamics, and in cases of diagnostic uncertainty, pericardiocentesis allows for fluid analysis to aid in diagnosis. In contemporary practice, the widespread availability of ultrasonography has made echocardiographic guidance the standard of care. Additional tools such as micropuncture technique, live ultrasonographic guidance, and adjunctive tools including fluoroscopy continue to advance and enhance procedural efficiency and safety. When performed by experienced operators, pericardiocentesis is a safe, effective, and potentially life-saving procedure.
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Affiliation(s)
- Zachary J Il'Giovine
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44106
| | - Ann Gage
- Centennial Heart, Tristar Centennial Medical Center, 2300 Patterson Street, Nashville, TN 37203
| | - Andrew Higgins
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44106.
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Eid F, Najim M, Elbanna M, Reda Mostafa M, Magdi M. Cardiac Arrest Following Retrieval of Inferior Vena Cava Filter: A Case Report and Literature Review of Pericardial Effusion and Cardiac Tamponade. Eur J Case Rep Intern Med 2023; 11:004192. [PMID: 38223284 PMCID: PMC10783465 DOI: 10.12890/2023_004192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024] Open
Abstract
This report presents the clinical details and management of a 58-year-old Caucasian male with pericardial effusion and cardiac tamponade following outpatient inferior vena cava (IVC) filter removal. The patient was unresponsive and experienced cardiac arrest minutes after the procedure, requiring cardiopulmonary resuscitation. After return of spontaneous circulation he displayed somnolence, confusion and chest discomfort. Investigations revealed a large pericardial effusion, and an echocardiography confirmed cardiac tamponade. Prompt intervention involved pericardiocentesis, resulting in haemodynamic stabilisation and reduction in effusion size. The patient responded favourably with treatment. Differential diagnoses were considered and treatment options were discussed, highlighting the importance of timely recognition and appropriate intervention in managing pericardial effusion and cardiac tamponade. This report adds to the limited literature on pericardial effusion and cardiac tamponade following a scheduled outpatient IVC filter removal, emphasising the unique clinical presentation and successful management of this rare phenomenon. LEARNING POINTS Understanding the link between pericardial effusion and cardiac tamponade following IVC filter removal.Recognising and differentiating cardiac tamponade from other emergencies using clinical and diagnostic tools.Learning the immediate management of cardiac tamponade, emphasising the role of pericardiocentesis.
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Affiliation(s)
- Fahad Eid
- Rochester Regional Health/Unity Hospital, Rochester, USA
| | - Mostafa Najim
- Rochester Regional Health/Unity Hospital, Rochester, USA
| | | | | | - Mohamed Magdi
- Rochester Regional Health/Rochester General Hospital, Rochester, USA
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3
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Adler Y, Ristić AD, Imazio M, Brucato A, Pankuweit S, Burazor I, Seferović PM, Oh JK. Cardiac tamponade. Nat Rev Dis Primers 2023; 9:36. [PMID: 37474539 DOI: 10.1038/s41572-023-00446-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/22/2023]
Abstract
Cardiac tamponade is a medical emergency caused by the progressive accumulation of pericardial fluid (effusion), blood, pus or air in the pericardium, compressing the heart chambers and leading to haemodynamic compromise, circulatory shock, cardiac arrest and death. Pericardial diseases of any aetiology as well as complications of interventional and surgical procedures or chest trauma can cause cardiac tamponade. Tamponade can be precipitated in patients with pericardial effusion by dehydration or exposure to certain medications, particularly vasodilators or intravenous diuretics. Key clinical findings in patients with cardiac tamponade are hypotension, increased jugular venous pressure and distant heart sounds (Beck triad). Dyspnoea can progress to orthopnoea (with no rales on lung auscultation) accompanied by weakness, fatigue, tachycardia and oliguria. In tamponade caused by acute pericarditis, the patient can experience fever and typical chest pain increasing on inspiration and radiating to the trapezius ridge. Generally, cardiac tamponade is a clinical diagnosis that can be confirmed using various imaging modalities, principally echocardiography. Cardiac tamponade is preferably resolved by echocardiography-guided pericardiocentesis. In patients who have recently undergone cardiac surgery and in those with neoplastic infiltration, effusive-constrictive pericarditis, or loculated effusions, fluoroscopic guidance can increase the feasibility and safety of the procedure. Surgical management is indicated in patients with aortic dissection, chest trauma, bleeding or purulent infection that cannot be controlled percutaneously. After pericardiocentesis or pericardiotomy, NSAIDs and colchicine can be considered to prevent recurrence and effusive-constrictive pericarditis.
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Affiliation(s)
- Yehuda Adler
- Sackler Faculty of Medicine, Tel Aviv University, Bnei Brak, Israel.
- College of Law and Business, Ramat Gan, Israel.
| | - Arsen D Ristić
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
| | - Massimo Imazio
- Cardiothoracic Department, Cardiology, University Hospital Santa Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, The University of Milan, Milan, Italy
| | - Sabine Pankuweit
- Department of Internal Medicine-Cardiology, Philipps University Marburg, Marburg, Germany
| | - Ivana Burazor
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Institute for Cardiovascular Diseases "Dedinje" and Belgrade University, Faculty of Medicine, Belgrade, Serbia
| | - Petar M Seferović
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Juarez A, Jhon GF, Khouzam R, Goodroe R, Stahl R, Faris M. Congenital Atrial Septal Defect Presenting With Tamponade Physiology and an Associated Viral Illness. Cureus 2023; 15:e41558. [PMID: 37554590 PMCID: PMC10405773 DOI: 10.7759/cureus.41558] [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: 07/08/2023] [Indexed: 08/10/2023] Open
Abstract
Cardiac tamponade is a serious clinical syndrome that often presents with the classic triad of hypotension, jugular vein distention and diminished or muffled heart sounds on auscultation (Beck's Triad). This phenomenon occurs due to fluid accumulation in the pericardial space which compresses the heart, reduces cardiac output and may cause cardiogenic shock. In this report, we present a case of a 22-year-old female with a congenital atrial septal defect (ASD) and right ventricular failure with tamponade physiology with an associated viral illness.
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Affiliation(s)
- Angel Juarez
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Gabriela F Jhon
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Rami Khouzam
- Cardiology, Grand Strand Medical Center, Myrtle Beach, USA
| | | | - Russell Stahl
- Cardiothoracic Surgery, Grand Strand Medical Center, Myrtle Beach, USA
| | - Mohamed Faris
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
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Masarweh OM, Vyas P, Knapp TM, Gonzalez-Morales U, Ammar A. A Case of Acute Purulent Streptococcus pneumoniae Pericarditis Causing Tamponade and Cardiac Arrest in a COVID-19-Infected Patient. Cureus 2023; 15:e39467. [PMID: 37362487 PMCID: PMC10290255 DOI: 10.7759/cureus.39467] [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: 05/12/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Purulent pericarditis due to Streptococcus pneumoniae (S. pneumoniae) has been increasingly rare since the advent of antibiotics; however, it still carries a high mortality rate, especially in the setting of tamponade. Bedside transthoracic echocardiogram (TTE) is a useful, cheap, and underutilized tool that can aid in the diagnosis, treatment, and further management of patients presenting to the emergency department with chest pain, as well as during cardiac resuscitation. In this report, we present a case of an acute purulent S. pneumoniae pericarditis of an unknown primary source in a patient coinfected with coronavirus disease 2019 (COVID-19) pneumonia, resulting in cardiac tamponade and cardiac arrest that resolved with the aid of bedside echocardiography-guided pericardiocentesis. We attempt to highlight the importance of clinicians using echocardiography to aid in their clinical decision-making, demonstrating it as a fast and effective tool capable of providing instantaneous feedback.
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Affiliation(s)
- Omar M Masarweh
- Internal Medicine, University of Central Florida, Kissimmee, USA
| | - Parag Vyas
- Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Thomas M Knapp
- Medicine, University of Central Florida College of Medicine, Orlando, USA
| | | | - Ali Ammar
- Cardiology, Orlando Health, Orlando, USA
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6
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Li K, Segura AM, Sun J, Chen Q, Cheng J, Perin EC, Elgalad A. Rare delayed cardiac tamponade in a pig after cardiac surgery. Vet Med Sci 2022; 8:1965-1968. [PMID: 35920114 PMCID: PMC9514471 DOI: 10.1002/vms3.892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective Delayed cardiac tamponade, a life‐threatening complication of pericardial effusion in humans, has rarely been described in large animal models. We report here a pig with cardiac tamponade that developed 29 days after cardiac surgery. Study Design Case report. Animals One 45‐kg domestic pig. Methods Open‐chest surgery was performed on a pig to induce chronic heart failure. At 15 days after surgery, the pig's breathing appeared laboured; induced heart failure was considered the cause. Routine heart failure medications were administered. Results On day 28, the pig's status deteriorated. On day 29, echocardiography performed just before the pig's death showed a large pericardial effusion, mainly in the lateral and anterior walls of the right heart, with several fibre exudation bands. The right heart was severely compressed with an extremely small right ventricle. An emergency sternotomy was unsuccessful. Pathologic examination showed a severely thickened, fibrous pericardium. The pericardial sac was distended (up to 4.5 cm) and was full of dark brown, soft, friable material. Epicardial haemorrhage with a fresh, organised thrombus was noted in the pericardium. Conclusion Delayed tamponade occurring at least 15 days after open‐chest surgery is easy to misdiagnose or overlook in large animal models where attention is often focused on primary pathological model changes. To decrease mortality in animal models, researchers should be aware of potential complications and use the same level of follow‐up monitoring of large animals as in clinical care.
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Affiliation(s)
- Ke Li
- Center for Preclinical Surgical and Interventional Research Texas Heart Institute Houston Texas USA
| | - Ana Maria Segura
- Department of Cardiovascular Pathology Texas Heart Institute Houston Texas USA
| | - Junping Sun
- Electrophysiology Basic Research Texas Heart Institute Houston Texas USA
| | - Qi Chen
- Electrophysiology Basic Research Texas Heart Institute Houston Texas USA
| | - Jie Cheng
- Electrophysiology Basic Research Texas Heart Institute Houston Texas USA
| | - Emerson C. Perin
- Center for Clinical Research Texas Heart Institute Houston Texas USA
| | - Abdelmotagaly Elgalad
- Center for Preclinical Surgical and Interventional Research Texas Heart Institute Houston Texas 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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8
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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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Begic E, Iglica A, Gojak R, Baljic R, Begic Z, Durak-Nalbantić A, Halilcevic M, D�ubur A, Begic A, Lepara O, Begic N, Šljivo A, Naser N, Stanetic B. Pericardial effusion in postcoronavirus disease patients with preserved ejection fraction of the left ventricle and normal values of N-Terminal-Pro B-Type natriuretic peptide-link with C-Reactive protein and D-Dimer. Int J Appl Basic Med Res 2022; 12:157-160. [PMID: 36131860 PMCID: PMC9484506 DOI: 10.4103/ijabmr.ijabmr_802_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/27/2022] [Accepted: 04/29/2022] [Indexed: 11/04/2022] Open
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Maffione F, Romano L, Di Sibio A, Brandolin D, Schietroma M, Carlei F, Giuliani A. A rare case of cardiac tamponade masquerading as acute abdomen. Int J Surg Case Rep 2020; 77S:S121-S124. [PMID: 32967813 PMCID: PMC7876917 DOI: 10.1016/j.ijscr.2020.08.062] [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: 06/08/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 11/11/2022] Open
Abstract
Acute abdomen is any acute abdominal condition requiring a quick response. The abdominal discomfort associated with extra-abdominal pathologies could mimic acute abdomen. Cardiac tamponade is a medical emergency. The differential diagnosis could be kept in mind to avoid a delayed treatment.
Introduction Acute abdomen is any acute abdominal condition requiring a quick response. The incidence varies according to age and disease aetiology. The abdominal discomfort associated with extra-abdominal pathophysiology and thoracic conditions could mimic acute abdomen. In this case we report a rare case of a young patient with cardiac tamponade masquerading as acute abdomen. Presentation of case A 25-years-old African man presented to the Emergency Department with abdominal pain. An EKG was performed, which revealed sinus tachycardia, with electrical alternans and borderline reduced voltage. At the time of the admission to our unit, he had a clinical worsening and a CT scan of abdomen was performed, which demonstrated hepatomegaly, abundant pericardial effusion and thin right pleural effusion at the lung bases. An echocardiogram confirmed a circumferential pericardial effusion with initial collapse of the right ventricular free wall. It was decided to immediately transport the patient to the Cardiosurgery Unit of another hospital to undergo pericardiocentesis. Discussion Our experience with this case underlines the important point that patients with a large pericardial effusion may present with the clinical features of acute abdomen and peritonitis. Abdominal pain was the primary symptom that prompted this patient to seek medical attention. Conclusion Acute abdomen is any acute abdominal condition requiring a rapid, often surgical, treatment. Cardiac tamponade is a medical emergency. The differential diagnosis could be kept in mind by any emergency physician, surgeon and anaesthesiologist, because an incorrect diagnosis and therefore an incorrect treatment or a delay in pericardial evacuation can be life-threatening.
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Affiliation(s)
- Francesco Maffione
- Department of General Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Italy
| | - Lucia Romano
- Department of General Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Italy.
| | - Alessandra Di Sibio
- Department of Radiology, S. Salvatore Hospital, Via L. Natali, 1, 67100, L'Aquila, Italy
| | - Denise Brandolin
- Department of General and Emergency Surgery, Giuseppe Mazzini Hospital, Teramo, Italy
| | - Mario Schietroma
- Department of General Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Italy
| | - Francesco Carlei
- Department of General Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Italy
| | - Antonio Giuliani
- Department of General Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Italy
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de Farias LDPG, Strabelli DG, Fonseca EKUN, Loureiro BMC, Nomura CH, Sawamura MVY. Thoracic tomographic manifestations in symptomatic respiratory patients with COVID-19. Radiol Bras 2020; 53:255-261. [PMID: 32904780 PMCID: PMC7458567 DOI: 10.1590/0100-3984.2020.0030] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/23/2020] [Indexed: 12/15/2022] Open
Abstract
China was the epicenter for the novel coronavirus disease (COVID-19), which quickly spread to other Asian countries and later to Western countries; subsequently, COVID-19 was categorized as a pandemic by the World Health Organization. Diagnosis primarily depends on viral detection in respiratory samples; however, available kits are limited, lack high sensitivity, and have a long turnaround time for providing results. In this scenario, computed tomography has emerged as an efficient and available high-sensitivity method, allowing radiologists to readily recognize findings related to COVID-19. The objective of this article is to demonstrate the main tomographic findings in symptomatic respiratory patients with COVID-19 to assist medical professionals during this critical moment.
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Affiliation(s)
- Lucas de Pádua Gomes de Farias
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Daniel Giunchetti Strabelli
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | | | - Bruna Melo Coelho Loureiro
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Cesar Higa Nomura
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Márcio Valente Yamada Sawamura
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
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Ansari-Gilani K, Gilkeson RC, Kikano EG, Hoit BD. Multimodality approach to the diagnosis and management of constrictive pericarditis. Echocardiography 2020; 37:632-636. [PMID: 32240548 DOI: 10.1111/echo.14649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 11/27/2022] Open
Abstract
Despite advances in cardiovascular imaging, the diagnosis of constrictive pericarditis remains challenging. A multimodality approach to the diagnosis of CP is essential to (a) fully assess the extent of pericardial thickening and calcification, (b) detect the functional and hemodynamic consequences of the constricting pericardium, and (c) implement the optimal management strategy in these often complex cases. This case-based review highlights the role and diagnostic ambiguities of multimodality imaging.
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Affiliation(s)
| | | | - Elias G Kikano
- University Hospital Cleveland Medical Center, Cleveland, Ohio
| | - Brian D Hoit
- Harrington Heart & Vascular Institute, University Hospital Cleveland Medical Center, Cleveland, Ohio
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Alerhand S, Carter JM. What echocardiographic findings suggest a pericardial effusion is causing tamponade? Am J Emerg Med 2019; 37:321-326. [DOI: 10.1016/j.ajem.2018.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/17/2018] [Accepted: 11/05/2018] [Indexed: 02/08/2023] Open
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Ahmed A, Harsha TS, Hamza T, Allen A, Mohamed E. Cardiac tamponade masquerading as gastritis: a case report. J Med Case Rep 2014; 8:264. [PMID: 25078658 PMCID: PMC4132358 DOI: 10.1186/1752-1947-8-264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/02/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Pericardial effusion and cardiac tamponade can develop in patients with virtually any condition that affects the pericardium. A high index of suspicion with proper diagnostic scheme can lessen the concomitant morbidity and mortality. Although cardiac tamponade mimics many medical conditions, internists and primary care physicians should be aware of the physiological and clinical aspects of the disease spectrum. CASE PRESENTATION A 31-year-old Caucasian man, with no significant past medical history, presented to our emergency room with acute upper abdominal heaviness of 2 hours' duration after drinking excessive amounts of alcohol in a short period of time (binge drinking). The coexistence of recent alcohol binge drinking and nonspecific abdominal complaints usually presume a diagnosis of gastritis in our daily encounters in the absence of hepatic, biliary or pancreatic derangements. We present a case in which the presenting abdominal pain turned out to be related to cardiac tamponade. CONCLUSIONS Cardiac tamponade is a sort of cardiogenic shock and is a medical emergency. Clinicians should understand the cardiac tamponade physiology, especially in cases without large pericardial effusion, and correlate the signs of clinical tamponade together with the echocardiographic findings. Drainage of cardiac tamponade is life-saving. A high index of suspicion with proper diagnostic arcades lessens the concomitant morbidity and mortality.
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Affiliation(s)
- Abuzaid Ahmed
- Creighton University Medical Center, 601 30th street, 5th floor, Omaha, NE 68131, USA.
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16
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Abstract
UNLABELLED The pericardium represents an important focus of morbidity and mortality in patients with cardiovascular disease. Fortunately, in recent years knowledge regarding this enigmatic part of the heart and the diagnosis of related diseases has substantially advanced. To a large extent, this can be attributed to the availability of several noninvasive cardiac imaging modalities. Transthoracic echocardiography, which combines structural and physiologic assessment, is the first-line technique for examination of patients suspected of having or known to have pericardial disease; however, cardiac computed tomography (CT) and magnetic resonance (MR) imaging are becoming increasingly popular for the study of this part of the heart. Modern multidetector CT scanners merge acquisition speed and high spatial and contrast resolution, with volumetric scanning to provide excellent anatomic detail of the pericardium. Multidetector CT is by far the modality of choice for depiction of pericardial calcifications. MR imaging is probably the best imaging modality for the acquisition of a comprehensive view of the pericardial abnormalities. MR imaging combines cardiac and pericardial anatomic assessment with tissue characterization and appraisal of the effects of pericardial abnormalities on cardiac performance. This review aims to elucidate the role of the pericardium and its interaction with the remainder of the heart in normal and pathologic conditions. It focuses on the rapidly evolving insights regarding pericardial disease provided by modern imaging modalities, not infrequently necessitating reconsideration of evidence that has thus far been taken for granted. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13121059/-/DC1.
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Affiliation(s)
- Jan Bogaert
- Department of Radiology, Medical Imaging Research Center, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
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Howard JP, Jones D, Mills P, Marley R, Wragg A. Recurrent ascites due to constrictive pericarditis. Frontline Gastroenterol 2012; 3:233-237. [PMID: 28839673 PMCID: PMC5369818 DOI: 10.1136/flgastro-2012-100173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 05/07/2012] [Indexed: 02/04/2023] Open
Affiliation(s)
- James Philip Howard
- NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK,Department of Cardiology, Barts and the London NHS Trust, London, UK
| | - Daniel Jones
- NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK,Department of Cardiology, Barts and the London NHS Trust, London, UK
| | - Peter Mills
- NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK
| | - Richard Marley
- Department of Gastroenterology, Barts and the London NHS Trust, London, UK
| | - Andrew Wragg
- NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK,Department of Cardiology, Barts and the London NHS Trust, London, UK
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Karhunen J, Raivio P, Maasilta P, Sihvo E, Suojaranta-Ylinen R, Vento A, Salminen US. Impact of early angiographic evaluation on the frequency of emergency reoperations after coronary bypass surgery. Scand J Surg 2010; 99:173-9. [PMID: 21044936 DOI: 10.1177/145749691009900313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS early graft failure following coronary bypass surgery results in elevated morbidity and mortality. This study focused on the impact of angiographic graft evaluation. MATERIAL AND METHODS of 5251 coronary artery bypass grafting (CABG) patients, 36 with postoperative persistent ischaemia underwent early angiography (23) or emergency resternotomy (13) 2000-2007 (Angiography era). Of the 23 patients, who underwent angiography, five were subsequently reoperated. Of 8807 CABG patients, 76 underwent postoperative emergency resternotomy 1988-1999 (Pre-angiography era) and served as controls. RESULTS the angiography era patients were older (64.0 years vs. 58.2 years, P = 0.002) and the proportion of female patients (22% vs. 43%, P = 0.029) was smaller. The rate of emergency reoperations decreased (0.86% vs 0.34%, P < 0.001) during the Angiography era and graft repairs (P = 0.013) or additional grafts (P = 0.006) were less frequent, although occluded anastomoses were observed more often (P = 0.043). In 5 Angiography era patients graft complications were corrected with percutaneous coronary intervention. ICU stay (5.72 + 0.98 days vs. 5.53 + 0.68 days) and hospital stay (12.2 + 1.54 days vs. 13.1 + 1.63 days) did not differ between the groups, but the rate of myocardial infarction (63.8% vs. 92.1%, P < 0.001) and in-hospital death (22.2% vs. 46.1%, P = 0.015) decreased. CONCLUSION after the introduction of early postoperative angiographic evaluation of CABG patients the rate of emergency reoperations and related morbidity and mortality decreased.
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Affiliation(s)
- J Karhunen
- Department of Orthopaedics and Traumatology, Jorvi Hospital, Espoo, Finland.
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Ginghina C, Beladan CC, Iancu M, Calin A, Popescu BA. Respiratory maneuvers in echocardiography: a review of clinical applications. Cardiovasc Ultrasound 2009; 7:42. [PMID: 19709411 PMCID: PMC2745370 DOI: 10.1186/1476-7120-7-42] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 08/26/2009] [Indexed: 11/23/2022] Open
Abstract
During echocardiographic examination, respiration induces cyclic physiological changes of intracardiac haemodynamics, causing normal variations of the right and left ventricle Doppler inflows and outflows and physiological variation of extracardiac flows. The respiration related hemodynamic variation in intra and extracardiac flows may be utilized in the echocardiography laboratory to aid diagnosis in different pathological states. Nevertheless, physiologic respiratory phases can cause excessive translational motion of cardiac structures, lowering 2D image quality and interfering with optimal Doppler interrogation of flows or tissue motion. This review focuses on the impact of normal respiratory cycle and provocative respiratory maneuvers in echocardiographic examination, both in physiological and pathological states, emphasizing their applications in specific clinical situations.
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Overlooked Constrictive Pericarditis as a Cause of Relapsing Ascites and Impairment of Renal Allograft Function. Transplant Proc 2009; 41:1949-50. [DOI: 10.1016/j.transproceed.2009.02.083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Accepted: 02/09/2009] [Indexed: 11/22/2022]
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Rosenbaum E, Krebs E, Cohen M, Tiliakos A, Derk CT. The spectrum of clinical manifestations, outcome and treatment of pericardial tamponade in patients with systemic lupus erythematosus: a retrospective study and literature review. Lupus 2009; 18:608-12. [DOI: 10.1177/0961203308100659] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Pericardial effusions causing pericardial tamponade are rare in patients with systemic lupus erythematosus (SLE). The goal of this study is to describe in detail the clinical and laboratory characteristics of a group of patients with pericardial effusions and pericardial tamponade secondary to SLE. We retrospectively reviewed the records of 71 patients with SLE, admitted to our Hospital between 1985 and 2006 with a diagnosis of pericarditis, pericardial effusion and tamponade. Clinical features in the patients with tamponade were compared with those with pericardial effusions without tamponade. Pericardial effusion and SLE was confirmed in 41 patients. Pericardial tamponade occurred in nine of these patients (21.9%) at the time of presentation. All tamponade patients were women. Patients with pericardial effusions who developed tamponade had a statistically significant ( P = 0.05) lower C4 level as compared with patients who did not develop tamponade. A pericardial window was required in five patients even though the patients were receiving high-dose corticosteroids. In the present series, all patients with tamponade were treated with high-dose corticosteroids though five of nine patients required a pericardial window in contrast to previous studies. A low C4 level at presentation was predictive of the development of tamponade physiology.
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Affiliation(s)
- E Rosenbaum
- Division of Rheumatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - E Krebs
- Division of Rheumatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Cohen
- Division of Rheumatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - A Tiliakos
- Division of Rheumatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - CT Derk
- Division of Rheumatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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