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Chyu KY, Shah PK. Electrocardiograms in Critical Care Cardiology. JACC Case Rep 2022; 4:101632. [PMID: 36507291 PMCID: PMC9730151 DOI: 10.1016/j.jaccas.2022.08.043] [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: 06/17/2022] [Revised: 07/24/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
Abstract
Patients with critical illness may present with electrocardiogram (ECG) findings with bizarre QRS morphology or abnormal amplitude. This article provides ECG examples from such clinical scenarios and discusses their clinical characteristics and significance. (Level of Difficulty: Beginner.).
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Affiliation(s)
| | - Prediman K. Shah
- Address for correspondence: Dr. Prediman K. Shah, Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, 127 South San Vicente Boulevard, Suite A-3307, Los Angeles, California 90048, USA.
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Patil A, Singh N, Vigneshwaran S, Bharti S, Sudhakar S. Sudden Death Due to Cardiac Tamponade Secondary to Myocardial Infarction Ventricular Wall Rupture. Cureus 2022; 14:e30288. [DOI: 10.7759/cureus.30288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/07/2022] Open
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Kiryu S, Ito Z, Ishikawa M, Akasu T, Matsumoto Y, Hirooka S, Saruta M, Koido S. Cancerous pericarditis presenting as cardiac tamponade in a 68-year-old man with pancreatic adenocarcinoma: a case report. J Med Case Rep 2020; 14:213. [PMID: 33158457 PMCID: PMC7648413 DOI: 10.1186/s13256-020-02546-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/02/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction Pericardial effusion is a rare complication of pancreatic cancer. We report a case of cardiac tamponade secondary to pancreatic cancer. Case presentation A 68-year-old Japanese man was diagnosed as having pancreatic cancer during surgery and received chemotherapy for 28 months after the diagnosis. He was admitted to the emergency room with severe dyspnea. Echocardiography revealed pericardial effusion with severe hypofunction. Emergency pericardial drainage was performed to maintain hemodynamics, which resulted in the elimination of 450 mL of blood and the maintenance of circulatory dynamics. Cytological examination of the pericardial fluid revealed atypical cells and tumor cells suggesting adenocarcinoma. Conclusions To our knowledge, pancreatic cancer complicated with cancerous pericarditis has not been previously documented. This case highlights the extreme severity of pericardial effusion, a sign of progressive disease, secondary to pancreatic cancer. In the case of neoplastic pericardial effusion, an extremely poor prognosis must be considered.
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Affiliation(s)
- Sachie Kiryu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan
| | - Zensho Ito
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan.
| | - Masashi Ishikawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan
| | - Takafumi Akasu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan.,Department of Pathology, The Jikei University School of Medicine, Kashiwa Hospital, Kashiwa City, Chiba, 277-8567, Japan
| | - Yoshihiro Matsumoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan
| | - Shinichi Hirooka
- Department of Pathology, The Jikei University School of Medicine, Kashiwa Hospital, Kashiwa City, Chiba, 277-8567, Japan
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, 105-8461, Japan
| | - Shigeo Koido
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan
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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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Cherian G, Uthaman B, Salama A, Habashy AG, Khan NA, Cherian JM. Tuberculous Pericardial Effusion: Features, Tamponade, and Computed Tomography. Angiology 2016; 55:431-40. [PMID: 15258689 DOI: 10.1177/000331970405500410] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The clinical features with particular reference to tamponade and mediastinal adenopathy were studied in tuberculous pericardial effusion. Tamponade is a frequent complication and the recognition of tuberculous etiology can be difficult. Involvement of the pericardium is mostly from mediastinal lymph nodes that have not been studied. This was a prospective cohort study. All patients had large effusions, and underwent pericardiocentesis and chest computed tomography. Patients with tuberculosis had specific therapy. Others with viral/idiopathic effusion served as controls for the computed tomography studies. There were 26 patients with tuberculosis: 18 had tamponade on echocardiography. All had symptoms. Fever (n=23) and dyspnea (n=20) were the most frequent presenting symptoms. Pericardial rub was heard in 14, and 3 had enlarged cervical or axillary nodes. Pulmonary tuberculosis was present in 6. Tuberculin skin test measured 17 ±3.3 mm. The biopsy specimen showed a granuloma in 22 of 24. All 26 had mediastinal lymph nodes >10 mm with a mean size of 19.5 ±8.6 mm that disappeared (81%) or regressed (19%) on treatment (p<0.001). Aortopulmonary nodes were most frequently enlarged (65.4%) and hilar the least. Three required pericardiectomy. At follow-up all were doing well. None with viral/idiopathic effusion had lymph node enlargement. Fever, dyspnea, and tamponade were frequent with tuberculosis. The prognosis was good with specific therapy. Mediastinal nodes were enlarged in all and only with tuberculosis and not with viral/idiopathic effusion. Nodes disappeared or regressed with treatment. In the appropriate clinical context, mediastinal lymph node enlargement on chest computed tomography along with a strongly positive skin test results could help in the diagnosis of a tuberculous etiology of pericardial effusion.
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Ohzeki M, Fujita SI, Miyazaki H, Morita H, Kanki S, Ozawa H, Katsumata T, Kurisu Y, Tsuji M, Tanigawa J, Sohmiya K, Hoshiga M, Ishizaka N. A patient with primary pericardial synovial sarcoma who presented with cardiac tamponade: a case report and review of the literature. Intern Med 2014; 53:595-601. [PMID: 24633030 DOI: 10.2169/internalmedicine.53.1749] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 36-year-old man presented with near-syncope. He was found to have massive pericardial effusion with a giant pericardial tumorous lesion. The pericardial effusion exhibited a bloody nature; however, neither malignant cells nor infectious organisms were detected. (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) showed an increased uptake of FDG in the pericardial tumor only. Although the tumor was not resectable, thoracotomy and tissue sampling were performed. A histological analysis showed CD99 positivity and SYT gene rearrangement, leading to a diagnosis of synovial sarcoma arising from the left lateral pericardial surface. The patient is now receiving chemotherapy.
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Shimizu S, Yajima M, Yoshii A, Nishikawa T, Ohta H. Malignant pericardial effusion and cardiac tamponade originating from uterine carcinosarcoma. Arch Gynecol Obstet 2008; 279:373-5. [DOI: 10.1007/s00404-008-0701-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 05/26/2008] [Indexed: 10/22/2022]
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