RESUMEN
Few clinical decision rules have been used to guide clinical management and predict outcomes in patients with pericardial tamponade. The objectives of this study are to identify the echocardiographic features associated with adverse outcomes in patients with pericardial effusions requiring pericardiocentesis and to apply a previously described four-point clinical and echocardiographic score to predict clinical outcomes over 24-hr, 30-day, and 1-year intervals. We performed a retrospective cohort review of patients who had transthoracic echocardiogram (TTE) performed and underwent pericardiocentesis within 48 h of emergency department presentation at two large tertiary care institutions. We constructed different stepwise logistic regression models and examined the associations of TTE characteristics and clinical features with ICU admission, hospital length of stay (h-LOS), and survival. The data set was then employed against a previously proposed scoring system to predict factors associated with clinical outcomes over 24 hr, 30 days, and 1 year. Two hundred thirty-nine patients were included in the final analysis. Echocardiographic characteristics of patients with pericardial tamponade who underwent pericardiocentesis are as follows: 69.1% right ventricular (RV) diastolic collapse, 62.3% exaggerated mitral valve (MV) inflow velocities, 56.4% inferior vena cava (IVC) plethora, and 53.4% right atrial (RA) systolic collapse. Increase in systolic blood pressure and increased variation in MV inflow velocity were associated with reduced ICU admission [OR: 0.94 (CI 0.90, 0.99), 0.28 (CI 0.09, 0.89), respectively]. In addition, a history of malignancy increased the length of hospital stay by about 3.89 days (CI 1.43-6.35, p < 0.01) and prior pericardiocentesis history was associated with 4.82-day increase in hospital stay (CI 1.19-8.45, p = 0.01). In utilizing the previously published prediction score, we found no statistically significant correlation in predicting survival. RV diastolic collapse and exaggerated MV inflow velocity were the most common echocardiographic findings in patients requiring pericardiocentesis. Contrary to prior studies, exaggerated MV inflow velocity was associated with reduced ICU admission. In addition, a previously described prediction score did not correlate with decreased survival in this cohort.
Asunto(s)
Taponamiento Cardíaco , Ecocardiografía , Pericardiocentesis , Humanos , Taponamiento Cardíaco/fisiopatología , Taponamiento Cardíaco/diagnóstico por imagen , Masculino , Femenino , Estudios Retrospectivos , Ecocardiografía/métodos , Ecocardiografía/estadística & datos numéricos , Persona de Mediana Edad , Pericardiocentesis/métodos , Anciano , Tiempo de Internación/estadística & datos numéricos , Valor Predictivo de las PruebasRESUMEN
A 55-year-old male with acute pericarditis presented with low-pressure cardiac tamponade (LPCT) unresponsive to volume infusion. Subsequent pericardiocentesis resulted in hemodynamic improvement and unmasking of pericardial constriction. This case provides illustrative hemodynamic tracings of LPCT. Additionally, the presence of concurrent pericardial constriction that may indicate a plausible underlying mechanism for the blunted responsiveness to fluid expansion in LPCT. The underlying physiologic processes and the associated hemodynamic tracings are discussed.
Asunto(s)
Taponamiento Cardíaco , Hemodinámica , Pericardiocentesis , Humanos , Taponamiento Cardíaco/fisiopatología , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/cirugía , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Pericarditis/fisiopatología , Pericarditis/terapia , Pericarditis/diagnóstico por imagen , Pericarditis/etiología , Pericarditis/diagnóstico , Enfermedad AgudaRESUMEN
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.
Asunto(s)
COVID-19/metabolismo , Taponamiento Cardíaco/fisiopatología , Derrame Pericárdico/fisiopatología , Adolescente , Taponamiento Cardíaco/complicaciones , Taponamiento Cardíaco/virología , Ecocardiografía/efectos adversos , Femenino , Humanos , Pericarditis/complicaciones , Pericarditis/diagnóstico , Factores de Riesgo , SARS-CoV-2/metabolismo , SARS-CoV-2/patogenicidad , Síndrome de Sotos/complicaciones , Síndrome de Sotos/virologíaRESUMEN
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.
Asunto(s)
Taponamiento Cardíaco , Fallo Renal Crónico/terapia , Derrame Pericárdico , Diálisis Peritoneal , Taponamiento Cardíaco/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Derrame Pericárdico/fisiopatología , Resultado del TratamientoRESUMEN
Hypereosinophilic syndrome is a rare entity and heterogeneous group of disorders characterized by hypereosinophilia and organ involvement. In this study, we presented a 49-year-old woman with cardiac tamponade in the context of Hypereosinophilic syndrome. Identifying hypereosinophilia as the underlying cause can have tremendous clinical implications for rapid initiation of appropriate treatment to minimize further end organ damage.
Asunto(s)
Encéfalo , Taponamiento Cardíaco , Ventrículos Cardíacos , Síndrome Hipereosinofílico , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/patología , Taponamiento Cardíaco/fisiopatología , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/fisiopatología , Humanos , Síndrome Hipereosinofílico/diagnóstico por imagen , Síndrome Hipereosinofílico/patología , Síndrome Hipereosinofílico/fisiopatología , Persona de Mediana EdadRESUMEN
For thousands of years, palpation of the peripheral pulse was the most important source of information for the physicians about their patients' circulation. The rate, amplitude, and pattern of the pulse served as a basis of amazing observations, although several of them have been also confirmed and substantiated by modern medicine. One of the classical signs is "paradoxical pulse" (PP), which signals potentially life-threatening conditions with various mechanisms in certain diseases. In our review, we demonstrate the pathophysiological bases of PP, and show the equivalents of this sign provided by modern medical equipments. Orv Hetil. 2020; 161(38): 1629-1635.
Asunto(s)
Taponamiento Cardíaco , Presión Sanguínea , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/fisiopatología , Humanos , Pulso ArterialRESUMEN
BACKGROUND: Cardiac tamponade is a potentially fatal complication after catheter ablation of ventricular arrhythmias. It often happens during or shortly after the procedure and needs urgent treatment. Here, we present a very incredible case about delayed cardiac tamponade after ablation of premature ventricular complexes. CASE PRESENTATION: A 66-year-old woman who underwent successful catheter ablation of right ventricular outflow tract origin premature ventricular complexes. Nineteen days after ablation, the patient experienced sudden syncope. Upon arriving at our hospital, she was "confused and shock". Transthoracic echocardiography revealed hemorrhagic cardiac tamponade, which was considered due to a delayed tiny perforation in the heart induced by the previous ablation. Following an emergent pericardiocentesis to drain a 200 mL hemorrhagic effusion, the patient's hemodynamics improved significantly. The patient was discharged after a 2-week hospitalization for investigating other probable causes with negative results. No signs of pericardial effusion recurred in a follow-up time of 12 months. CONCLUSION: This case report demonstrated, for the first time, that very late post-procedural cardiac tamponade might occur after catheter ablation of ventricular arrhythmias, even without antithrombotic treatment.
Asunto(s)
Taponamiento Cardíaco/etiología , Ablación por Catéter/efectos adversos , Lesiones Cardíacas/etiología , Derrame Pericárdico/etiología , Complejos Prematuros Ventriculares/cirugía , Anciano , Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/fisiopatología , Taponamiento Cardíaco/terapia , Femenino , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/fisiopatología , Lesiones Cardíacas/terapia , Hemodinámica , Humanos , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/fisiopatología , Derrame Pericárdico/terapia , Pericardiocentesis , Factores de Tiempo , Resultado del Tratamiento , Complejos Prematuros Ventriculares/diagnósticoRESUMEN
The vast majority of patients in the ongoing coronavirus Disease 2019 (Covid-19) pandemic primarily present with severe respiratory illness. We report a Covid-19 patient who presented with findings of acute coronary syndrome and was found to have purulent fulminant myopericarditis and cardiac tamponade. We compare our case to the previously reported instances of Covid-19-associated myocarditis. Through review of the available literature, we also highlight the potential mechanisms of cardiac injury in Covid-19. We hope to increase awareness amongst clinicians about this unusual presentation of Covid-19.
Asunto(s)
Taponamiento Cardíaco , Infecciones por Coronavirus , Miocarditis , Pandemias , Neumonía Viral , Betacoronavirus , COVID-19 , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/fisiopatología , Taponamiento Cardíaco/terapia , Taponamiento Cardíaco/virología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Miocarditis/diagnóstico , Miocarditis/fisiopatología , Miocarditis/terapia , Miocarditis/virología , Pericardiocentesis , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , SARS-CoV-2Asunto(s)
Taponamiento Cardíaco/etiología , Reanimación Cardiopulmonar/métodos , Infecciones por Coronavirus/complicaciones , Paro Cardíaco/etiología , Miocarditis/etiología , Neumonía Viral/complicaciones , Síndrome Respiratorio Agudo Grave/complicaciones , Anciano , COVID-19 , Taponamiento Cardíaco/fisiopatología , Taponamiento Cardíaco/terapia , Infecciones por Coronavirus/diagnóstico , Progresión de la Enfermedad , Resultado Fatal , Paro Cardíaco/fisiopatología , Paro Cardíaco/terapia , Humanos , Masculino , Miocarditis/fisiopatología , Miocarditis/terapia , Pandemias , Neumonía Viral/diagnóstico , Respiración Artificial/métodos , Síndrome Respiratorio Agudo Grave/diagnóstico , Síndrome Respiratorio Agudo Grave/terapia , EspañaRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Adulto , Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/fisiopatología , Derrame Pleural/complicaciones , Derrame Pleural/diagnóstico por imagen , Diagnóstico Diferencial , Taquipnea , Toracocentesis , EcocardiografíaRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Taponamiento Cardíaco/diagnóstico por imagen , Hipertensión Pulmonar/complicaciones , Pericardiocentesis/métodos , Taponamiento Cardíaco/fisiopatología , Taponamiento Cardíaco/cirugía , Enfermedades del Tejido Conjuntivo/complicaciones , Insuficiencia Cardíaca/complicacionesRESUMEN
Compressive pericardial physiology (i.e., cardiac tamponade) reduces ventricular chamber volume/filling and cardiac output, which exacerbates coexisting hemodynamic derangements. In this hemodynamic rounds, we demonstrate the interaction of two hemodynamic conditions in one patient with acute pericardial tamponade in the setting of aortic stenosis (AS). Simultaneous pressures across the aortic valve before and after relief of cardiac tamponade demonstrate an acute and uncommon improvement in the hemodynamics of AS.
Asunto(s)
Estenosis de la Válvula Aórtica/fisiopatología , Válvula Aórtica/fisiopatología , Taponamiento Cardíaco/fisiopatología , Hemodinámica , Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Taponamiento Cardíaco/complicaciones , Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/terapia , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/fisiopatología , Masculino , Persona de Mediana Edad , Pericardiocentesis , Recuperación de la Función , Resultado del Tratamiento , Función Ventricular IzquierdaRESUMEN
BACKGROUND: Cardiac tamponade is a rare but serious complication of Takotsubo cardiomyopathy (TC). Two cases of cardiac tamponade subsequent to TC have been reported. The pericardial effusion in these cases was hemorrhagic and caused by ventricular rupture. Cardiac tamponade induced by an inflammatory effusion complicated with TC has not been reported. This is the first case report of TC, which developed cardiac tamponade during the recovery phase with a large volume non-hemorrhagic inflammatory effusion. CASE PRESENTATION: We describe a case of an 81-year-old woman admitted to our hospital because of severe chest pain. Her symptoms began soon after her son's hospitalization. We diagnosed her with TC based on results of an electrocardiogram, echocardiogram, and emergent coronary angiography. Her symptoms and left ventricular dysfunction improved gradually. She developed newly confirmed chest pain and dyspnea on day 9 after admission. A large pericardial effusion developed, resulting in cardiac tamponade. Her symptoms and hemodynamic status improved immediately after the pericardiocentesis. The effusion was non-hemorrhagic and exudative. No specific signs of infection, collagen disease, or malignant tumors were observed, except for TC. CONCLUSIONS: We experienced a case of circulatory collapse induced by TC-related inflammatory pericardial effusion at recovery phase. This case emphasizes the importance of careful follow-up even after improved left ventricular dysfunction in a patient with TC.
Asunto(s)
Taponamiento Cardíaco/etiología , Derrame Pericárdico/etiología , Cardiomiopatía de Takotsubo/complicaciones , Anciano de 80 o más Años , Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/fisiopatología , Taponamiento Cardíaco/cirugía , Femenino , Hemodinámica , Humanos , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/fisiopatología , Derrame Pericárdico/cirugía , Pericardiocentesis , Recuperación de la Función , Cardiomiopatía de Takotsubo/diagnóstico por imagen , Cardiomiopatía de Takotsubo/fisiopatología , Resultado del Tratamiento , Función Ventricular IzquierdaAsunto(s)
Implantación de Prótesis Vascular/instrumentación , Taponamiento Cardíaco/cirugía , Cateterismo Periférico/instrumentación , Oxigenación por Membrana Extracorpórea/instrumentación , Derrame Pericárdico/cirugía , Técnicas de Ventana Pericárdica , Dispositivos de Acceso Vascular , Lesiones del Sistema Vascular/cirugía , Oclusión con Balón , Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/fisiopatología , Cateterismo Periférico/efectos adversos , Oxigenación por Membrana Extracorpórea/efectos adversos , Femenino , Hemodinámica , Humanos , Persona de Mediana Edad , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/fisiopatología , Recurrencia , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/fisiopatologíaAsunto(s)
Taponamiento Cardíaco , Descompresión Quirúrgica/métodos , Insuficiencia Cardíaca/cirugía , Corazón Auxiliar , Complicaciones Posoperatorias , Implantación de Prótesis/efectos adversos , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/fisiopatología , Taponamiento Cardíaco/cirugía , Diagnóstico Diferencial , Femenino , Insuficiencia Cardíaca/fisiopatología , Hemodinámica , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Implantación de Prótesis/instrumentación , Implantación de Prótesis/métodos , Flujo Pulsátil , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
Pericarditis refers to the inflammation of the pericardial layers, resulting from a variety of stimuli triggering a stereotyped immune response, and characterized by chest pain associated often with peculiar electrocardiographic changes and, at times, accompanied by pericardial effusion. Acute pericarditis is generally self-limited and not life-threatening; yet, it may cause significant short-term disability, be complicated by either a large pericardial effusion or tamponade, and carry a significant risk of recurrence. The mainstay of treatment of pericarditis is represented by anti-inflammatory drugs. Anti-inflammatory treatments vary, however, in both effectiveness and side-effect profile. The objective of this review is to summarize the up-to-date management of acute and recurrent pericarditis.