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PubMed1991

Delayed traumatic intrapericardial diaphragmatic hernia associated with cardiac tamponade.

We describe a case of delayed presentation of traumatic intrapericardial diaphragmatic hernia associated with cardiac tamponade. A 71-year-old woman presented to our emergency department complaining of epigastric and midabdominal pain one month after hospitalization for multiple injuries suffered in an automobile accident. Chest radiograph showed a diaphragmatic hernia. In the ED, the patient became hypotensive and tachycardic with elevated central venous pressure. At surgery, she was found to have omentum and transverse colon herniated into the pericardial sac causing cardiac tamponade. The defect was repaired, and her postoperative course was uncomplicated. Cardiac tamponade should be included in the differential diagnosis of hypotension in patients with radiographic evidence of diaphragmatic hernia.

Aged↗
PubMed1994

Doppler echocardiography in cardiac tamponade and constrictive pericarditis.

Doppler echocardiography has greatly facilitated the assessment of patients with compressive cardiac disease. Patients in whom cardiac tamponade or pericardial constriction are suspected should undergo a complete echocardiographic examination including careful Doppler analysis of transmitral flow and inflow through the hepatic vein or superior vena cava (SVC). Monitoring of both the electrocardiogram and the phase of respiration are an integral part of this examination. Patients with cardiac tamponade exhibit a > 25% reduction in E wave velocity during the first inspiratory cardiac cycle; they exhibit predominant systolic inflow through the hepatic vein or SVC (with a predominant X descent with little or no Y descent). In constrictive pericarditis the pattern of transmitral flow variation is comparable to that observed in cardiac tamponade, however, a prominent Y descent is often observed on hepatic vein or SVC Doppler study. Similar changes with respiration may be observed in mitral inflow in obese patients or in those with chronic obstructive pulmonary disease, however, in these conditions the nadir of E wave velocity is observed 2-3 cardiac cycles after the first inspiratory beat. Restrictive cardiomyopathy may produce a similar systemic venous flow pattern, but increased inspiratory flow reversals and lack of respiratory variation in transmitral flow velocity distinguish it from constrictive pericarditis.

Cardiac Tamponade↗
PubMed2002

Pericardial effusion with cardiac tamponade as a form of presentation of primary hypothyroidism.

The authors describe a case of pericardial effusion accompanied by cardiac tamponade caused by primary hypothyroidism. Diagnosis was made by exclusion, because other causes of cardiac tamponade are more frequent. Emergency treatment of cardiac tamponade is pericardiocentesis (with possible pericardial window), and, after stabilization, performance of hormonal reposition therapy with L-thyroxin.

Cardiac Tamponade↗
PubMed1998

Amebic liver abscess complicated with cardiac tamponade and mediastinal abscess.

Amebic pericarditis is an extremely rare complication of liver abscess and an uncommon etiology of sterile pericardial effusion with cardiac tamponade. The association of mediastinal abscess in this clinical setting has not been reported in the literature. Herein, we describe a case of amebic liver abscess complicated with mediastinal abscess and amebic pericarditis with cardiac tamponade. A 44-year-old man was admitted to our hospital because of shortness of breath for the previous 2 days. Cardiac tamponade was diagnosed and emergency pericardiectomy was performed. Chocolate-like pus was found in the pericardial sac and mediastinal space during surgery. Abdominal computed tomography revealed an ill-defined hypodense lesion over the left lobe of the liver, suggesting a liver abscess. Amebic liver abscess and pericarditis were diagnosed on the basis of a high serum titer of amebic antibodies on hemagglutination test. The patient was treated with metronidazole for 2 weeks and discharged in good condition. This case should alert clinicians to the possibility of amebic pericarditis in patients with cardiac tamponade associated with chocolate-like sterile pus in the pericardium and mediastinum. To establish the diagnosis of amebic pericarditis, one should investigate the presence of a liver abscess, a high serum titer of amebic hemagglutination antibodies, and the presence of Entamoeba histolytica trophozoites in the pericardium or pericardial aspirate.

Abscess↗
PubMed1997

Cardiac tamponade in Taiwan.

We retrospectively reviewed all of the patients who were treated for cardiac tamponade at Linkou Chang Gung Memorial Hospital between January 1991 and December 1995. There were a total of 112 patients (57 males, 55 females) with a mean age of 51 +/- 14 years (53 +/- 15, 49 +/- 13, respectively). Dyspnea was the most common complaint (85%). The mean blood pressure was 129 +/- 24/78 +/- 17 mmHg, and only 8% had a systolic blood pressure of less than 90 mmHg. Sinus tachycardia was the most frequent electrocardiographic finding (72%, 62/86). Diffuse low voltage was noted in 35% (30/86) of the patients and electrical alternans was seen in 17% (15/86). The mean volume of pericardial effusion was 610 +/- 263 ml. Sixty-five percent of the pericardial effusions were bloody, 31% were serosanguineous, 2% were purulent and 2% were chylous. Overall, 54.5% of the patients had malignant diseases. Of the 61 patients who died, 79% had malignancies. Thirty-five (57%) of these 48 patients had lung cancer. The mean survival time from emergent pericardiocentesis was 3.4 months. In conclusion, non-traumatic cardiac tamponade had a poor prognosis because most patients had malignant etiologies. There is still no definitive treatment for recurrent malignant pericardial effusion-induced cardiac tamponade. Percutaneous pericardiocentesis as clinically required may be the most appropriate treatment, since it is questionable whether such subjects should be subjected to the unnecessary pain and suffering associated with an operative procedure, considering their short mean survival time.

Adolescent↗
PubMed1991

Experimental cardiac tamponade: a hemodynamic and Doppler echocardiographic reexamination of the relation of right and left heart ejection dynamics to the phase of respiration.

A hallmark of cardiac tamponade is pulsus paradoxus. However, the exact mechanism of pulsus paradoxus and the relation of left and right ventricular ejection dynamics remain controversial, with some studies suggesting an inverse relation in ventricular filling and ejection and others citing a more important role for the effects of right heart ejection dynamics delayed by transit through the pulmonary artery bed. To specifically reexamine this issue, six sedated but spontaneously breathing dogs were studied during experimental cardiac tamponade with use of extensive hemodynamic instrumentation and Doppler methods. During cardiac tamponade, left ventricular systolic pressure decreased from 125.8 +/- 12.1 to 81.7 +/- 26.7 mm Hg (p less than 0.01) and cardiac output from 5.86 +/- 1.48 to 2.34 +/- 0.98 liters/min (p less than 0.001); mean pericardial pressure increased from -1.2 +/- 0.8 to 10.5 +/- 3 mm Hg (p less than 0.001) and pulsus paradoxus from 4.3 +/- 1.6 to 10.7 +/- 1.2 mm Hg (p less than 0.001) compared with baseline values. An inverse relation in left and right ventricular ejection dynamics that was very close to 180 degrees out of phase was seen throughout the respiratory cycle in multiple hemodynamic and Doppler variables including peak systolic pressures, aortic and pulmonary flow velocities and ventricular ejection times. Simultaneous recording of the transmitral pressure gradient provided indirect evidence that the ventricular ejection dynamics were directly related to changes in ventricular filling. However, the magnitude of ventricular pressure or output flow velocity for each respiratory cycle was variable, depending on the exact timing of filling and ejection in relation to the phase of respiration. Variation in left ventricular output due to changes in right ventricular output delayed by transit through the pulmonary vasculature was not recognized in any animal. It is concluded that in spontaneously breathing dogs with acute cardiac tamponade, peak ventricular pressures, ventricular ejection times and pulmonary and aortic flow velocities have an inverse relation that is very close to 180 degrees out of phase.

Animals↗
PubMed1995

[Cardiac tamponade with the absence of a paradoxical pulse. The practical utility of echocardiography].

A patient with cardiac tamponade but without hypotension and pulsus paradoxus is reported. In this patient, echocardiography confirmed the diagnosis of cardiac tamponade, showing diastolic collapse of the right ventricle and also the presence of an atrial septal defect (ostium secundum) that explains the absence of pulsus paradoxus. The role of echocardiography in those rare clinical situations that in the presence of cardiac tamponade showed no pulsus paradoxus are discussed.

Cardiac Tamponade↗
PubMedDate not supplied

Cardiac tamponade in dogs with normal coronary arteries. I. Effect of changing intravascular volume on hemodynamics and myocardial blood flow.

Intravascular volume expansion has been shown to improve cardiac output in experimental cardiac tamponade. To determine the limitations of intravascular volume manipulation, acute tamponade was created in 20 anesthetized, spontaneously breathing dogs. The intrapericardial volume causing tamponade was determined for each animal, and kept constant. Hemodynamics were recorded with and without tamponade at multiple levels of intravascular volume. During cardiac tamponade, intravascular volume expansion increased cardiac output only in animals which were initially volume-depleted. Volume expansion of normovolemic or hypervolemic animals caused minimal changes in cardiac output, but increased atrial and aortic pressures. Intravascular volume depletion of the normovolemic animal caused a significant decline in cardiac output, in contrast to the trend towards an increased output following phlebotomy of the volume-expanded animals. In general, the benefit of intravascular volume expansion during cardiac tamponade could only be demonstrated when atrial pressures were below 12 mm Hg.

Animals↗
PubMed2004

[Perforating mediastinal mature teratoma associated with acute cardiac tamponade; report of a case].

We report a case of the mediastinal teratoma associated with acute cardiac tamponade followed by emergency operation. This tumor causes a variety of complications, but reports of acute cardiac tamponade have been rare. 20-year-old male admitted into our hospital with complaint of the chest pain, who was diagnosed with mediastinal tumor. She was admitted due to sudden fever up, and 5 days after admission, the complaint of severe epigastralgia and abdominal swelling were occurred. A chest X-ray film and chest computed tomography (CT) revealed cardiac tamponade. We carried out emergency surgical pericardial drainage and extirpation of the tumor. The tumor was composed of cystic part involving of dark green fluid macroscopically. The amylase level in this fluid was 42 U/l. We observed a small hole on the pericardial sac beside the base of ascending aorta. The amylase level in pericardial effusion was 19 U/l. Histopathological diagnosis was mature teratoma perforating into pericardiac sac, which included skin, bronchus and pancreatic tissue. We concluded that the progress of the tumor and the mechanical inflammation were major cause of perforation of the tumor into the pericardial sac, and autodigestion by enzyme from pancreas was minor cause of perforation.

Acute Disease↗
PubMed1978

Extrinsic compression of the heart by tumor masquerading as cardiac tamponade.

A patient with known intrathoracic tumor presented with findings suggestive of cardiac tamponade. At cardiac catheterization, the entire heart was displaced superiorly and anteriorly by the tumor mass, and this accounted for the observed cardiac hemodynamics, in the absence of discernible pericardial effusion.

Cardiac Tamponade↗
PubMed1991

Delayed cardiac tamponade after blunt chest trauma: case report.

A case of cardiac tamponade without evidence of hemopericardium within 2 weeks after blunt chest trauma is reported. The cause was a pericardial effusion that may have resulted from the post-cardiac injury syndrome. Pericardiotomy drained 600 mL of straw-colored clear fluid. A high index of suspicion for cardiac tamponade must be maintained in such patients for weeks after injury.

Adult↗
PubMed1977

Late cardiac tamponade following open-heart surgery: detection by echocardiography.

Late cardiac tamponade following open-heart operation is a potentially lethal complication that is often difficult to diagnose. A case of cardiac tamponade occurring two weeks after left ventricular aneurysmectomy and coronary bypass surgery is reported. Despite opening of the anterior pericardium during operation, echocardiography revealed characteristic findings, which permitted prompt recognition of this disorder.

Angina Pectoris↗
PubMed2001

Extrapericardial cardiac tamponade caused by traumatic retrosternal hematoma.

Cardiac tamponade is an uncommon complication of blunt chest trauma, resulting typically from hemorrhage into the pericardial space. We report a case of hemodynamic compromise secondary to an extrapericardial compression caused by the acute formation of a retrosternal hematoma associated with a sternal fracture. The patient was involved in a violent deceleration accident. Initially, he only complained of an anterior thoracic pain, but subsequently became restless, pale, and dyspneic. A severe hypotension associated with sinus bradycardia (45 bpm) rapidly occurred. Both jugular veins became markedly turgescent, but no significant pulsus paradoxus was noted. Echocardiography disclosed a large hematoma, compressing anteriorly both the right ventricular cavity and outflow tract. Surgical evacuation of the retrosternal hematoma related to a bifocal fracture of the manubrium was followed by instantaneous hemodynamic improvement. Regional extrapericardial tamponade secondary to the acute formation of compressive retrosternal hematoma is an unusual cause of circulatory failure after severe blunt chest trauma. Since conventional clinical signs associated with typical tamponade physiology may be lacking in this setting, echocardiography is ideally suited for early recognition of this unusual condition.

Accidents, Traffic↗
PubMed2000

Detection of iatrogenic cardiac tamponade by transesophageal echocardiography during vena cava filter procedure.

PURPOSE: To present a patient who developed cardiac tamponade during insertion of an inferior vena cava (IVC) filter. Intraoperative transesophageal echocardiography (TEE) was used as a means to diagnose the cardiac tamponade and to facilitate guiding of pericardiocentesis. CLINICAL FEATURES: A 45-yr-old man with protein S deficiency complicated by repeated attacks of deep vein thrombosis and pulmonary thromboembolism was scheduled for insertion of an IVC filter. He had history of chronic renal insufficiency, heart failure, and cerebral infarction with mild left hemiparesis. Current medication included diltiazem (30 mg, I tab tid ), prednisolone (5 mg, 2 tabs qd ), and warfarin (2.5 mg daily). Preoperative transthoracic echocardiography demonstrated bilateral pleural effusions, moderate mitral regurgitation and tricuspid regurgitation, left atrial appendage thrombus and severe generalized hypokinesia of left ventricle. Nuclear medicine examination by (99)Tc showed ejection fractions of left ventricle and right ventricle as 20% and 22%, respectively. Under the impression of protein S deficiency with multiple attacks of thromboembolism and failure of anticoagulant therapy, he was arranged for the procedure of vena caval filter insertion. Unfortunately, iatrogenic cardiac tamponade occurred during the course of the procedure with rapid hemodynamic deterioration. Because of the expedient of routine monitoring of cardiac condition with TEE, a prompt diagnosis was made. We successfully improved the patient's hemodynamic status after transthoracic echo-guided pericardiocentesis. CONCLUSION: Intraoperative TEE is recommended to be used routinely in patients undergoing vena cava filter procedures. The availability of echocardiographic monitoring in the operation room allows the confirmation of the diagnosis and facilitation pericardiocentesis.

Cardiac Tamponade↗
PubMed2006

Raised international normalized ratio: an early warning for a late cardiac tamponade?

Seven consecutive cases of late cardiac tamponade after valvular surgery are reported; all were postoperatively treated with acenocoumarol and 6 had an international normalized ratio peak greater than 6.0 within 3 days preceding tamponade. It is suggested that during this excessive anticoagulation state a hemorrhagic event within the pericardial space precipitates the tamponade. In addition, it is proposed that all valve patients with a postoperative international normalized ratio peak greater than 5.0 within 6 weeks postoperatively should be considered for a transthoracic echocardiogram.

Acenocoumarol↗
PubMed1986

The shift in the relationship between intrapericardial fluid pressure and volume induced by acute left ventricular pressure overload during cardiac tamponade.

We hypothesized that a process leading to an acute increase in cardiac size would change the relationship between intrapericardial pressure and fluid volume during cardiac tamponade, resulting in a change in the time of onset of right ventricular diastolic collapse (RVDC) as seen on the two-dimensional echocardiogram. Five spontaneously breathing dogs were instrumented to measure ascending aortic and right atrial blood pressures and intrapericardial pressure (IPP). A hydraulic occluder was placed around the proximal descending thoracic aorta. Each animal underwent six consecutive episodes of cardiac tamponade, three in the presence alternating with three in the absence of aortic constriction. The onset of RVDC was recorded and the volume infused into the pericardial space was measured. In the presence of aortic constriction, the relationship between pericardial pressure and incremental pericardial fluid volume was shifted so that IPP was an average of 3.4 mm Hg higher at any given intrapericardial fluid volume (p less than .001). At the onset of RVDC, the mean IPP was higher and the intrapericardial fluid volume was lower during aortic constriction than under control conditions (p less than .001 for both comparisons). Thus, a rapid increase in left ventricular volume in the presence of an otherwise unimportant pericardial effusion may increase intrapericardial fluid pressure sufficiently to cause RVDC.

Animals↗
PubMed1981

[Diagnosis and therapy of cardiac tamponade. An analysis of 50 patients].

Cardiac tamponade (CT) is a life-threatening complication of pericardial effusion which must be diagnosed and treated as soon as possible. The diagnostic value of the various symptoms and clinical signs, and the problems of pericardial puncture and drainage are reviewed in a group of 50 patients. Dyspnea was the most frequent symptom (92%), while elevated jugular venous pressure and pulsus paradoxus were the dominant findings in all patients. Non-specific enlargement of cardiac shadow on chest x-ray (98%) and low voltage in the electrocardiogram (62%) also provided important diagnostic information. However, echocardiography was the most reliable method of confirming the presence of pericardial fluid and assessing its quantity. The underlying cause of CT was most often malignant tumor (58%), followed by uremia (16%), idiopathic pericarditis (12%) and post-cardiotomy syndrome (10%). Removal of the pericardial fluid resulted in rapid improvement in all cases. Left parasternal drainage under echocardiographic control in 23 patients with a broad (greater than 10 mm) anterior echofree space proved to be a rapid and safe alternative to subxiphoidal puncture or surgical drainage. Longterm prognosis depends on the underlying disease. As might be expected, survival time is usually short in malignant pericarditis; however, even such cases warrant active treatment to relieve subjective symptoms.

Adult↗