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PubMed1999

Correlation between clinical and Doppler echocardiographic findings in patients with moderate and large pericardial effusion: implications for the diagnosis of cardiac tamponade.

BACKGROUND: Clinical data are of unquestionable value for management purposes in cardiac tamponade, whereas the precise value of Doppler echocardiographic findings is not yet fully understood. We aimed to prospectively assess the correlation between clinical and Doppler echocardiographic signs in the diagnosis of cardiac tamponade in a large series of patients with pericardial effusion. METHODS: During a 2-year period, all patients with moderate and large pericardial effusion were prospectively assessed. The presence of clinical findings suggesting cardiac tamponade, right cardiac chamber collapse on the echocardiogram, and Doppler venous flow pattern were simultaneously evaluated. RESULTS: One hundred ten patients were included (49 with moderate and 61 with large effusions). Thirty-eight patients showed clinical features suggestive of cardiac tamponade and 72 did not. In patients with clinical tamponade, 90% had collapse of one or more right cardiac chambers, but 4 (10%) did not have any collapse. Venous flow was analyzable in 63%, suggesting tamponade in 75% of the patients. In patients without clinical tamponade, 34% showed collapse of one or more cardiac chambers. Venous flow pattern was normal in 80%, inconclusive in 11%, and only suggestive of tamponade in 9% of patients. If clinical features of tamponade were considered the diagnostic standard, sensitivity and specificity would be 90% and 65% for the presence of any collapse, 68% and 66% for right atrial collapse, 60% and 90% for right ventricular collapse, and 45% and 92% for simultaneous collapse of both chambers. Sensitivity and specificity of venous flow analysis would be 75% and 91%, respectively. CONCLUSIONS: There is a good correlation between absence of collapse and absence of tamponade, but the correlation is poor between collapse and tamponade. Abnormal venous flow has a good correlation with clinical features of tamponade, with a higher sensitivity than right ventricular collapse and a much higher specificity than right atrial collapse.

Cardiac Tamponade↗
PubMed1977

Echocardiographic study of cardiac tamponade.

We studied 14 patients with cardiac tamponade and pulsus paradoxus; 11 were studied after relief of tamponade by pericardiocentesis. Right ventricle diastolic diameter increased during inspiration in each of 12 patients; left ventricle diastolic diameter decreased during inspiration in each of 13. Mitral valve DE amplitude decreased with inspiration in 13 of 14 patients. Mitral valve E-F slope could be measured in eight patients, and was rounded and not measurable in six. Six of the eight showed inspiratory decrease in mitral E-F slope. Similar changes were observed in two other patients with pulsus paradoxus who had chronic obstructive airway disease. Twenty patients with large pericardial effusions and no tamponade did not show these changes. These results suggest inspiratory augmentation of right ventricular filling and inspiratory diminution of left ventricular filling, not only in cardiac tamponade, but in obstructive airway disease associated with pulsus paradoxus.

Aortic Valve↗
PubMedDate not supplied

Late cardiac tamponade after open heart surgery.

Delayed cardiac tamponade after open heart surgery is relatively uncommon, but constitutes a life-threatening condition that must be diagnosed and managed promptly. We report 21 patients who developed cardiac tamponade 5 to 53 days after open heart operations. Possible etiological factors included anticoagulant therapy (19 patients), excessive mediastinal drainage in the postoperative period (10 patients), postpericardiotomy syndrome (4 patients), and coagulation disorders (1 patient). The clinical presentation was insidious and the diagnosis was often difficult to establish at the outset. A high index of clinical suspicion and echocardiography were the most reliable means to reach an early diagnosis. Twenty patients in whom delayed tamponade was suspected were operated and all of them survived. In one patient tamponade was not diagnosed antemortem and he died; on autopsy left heart compression by a large loculated clot was found. Decompression of the pericardial space can be accomplished by pericardiocentesis or by surgical means (subxiphoid pericardiotomy, median sternotomy, or thoracotomy). Although pericardiocentesis alone may be effective, mainly when the postpericardiotomy syndrome is the suspected etiology, we recommend open procedures since the presence of blood clots and adhesions has been a frequent finding.

Acenocoumarol↗
PubMed2001

Lung cancer presenting as cardiac tamponade associated with transmural myocardial ischaemia.

Cardiac tamponade due to carcinomatous pericarditis is a life-threatening complication of malignancy and is uncommon as its initial manifestation [Chest 88 (1985) 70; Cancer 45 (1980) 1697; J Am Med Assoc 257 (1987) 1088]. A case of lung cancer presenting with cardiac tamponade associated with transient ST-segment elevation and life-threatening arrhythmias is presented. To our knowledge, this is the first reported case of transmural myocardial ischaemia related to malignancy.

Cardiac Tamponade↗
PubMed2001

Acute type A aortic dissection: the prognostic impact of preoperative cardiac tamponade.

OBJECTIVE: Acute type A aortic dissection requires emergency surgery and is associated with considerable mortality. The aim of the study was to evaluate whether occurrence of preoperative cardiac tamponade with or without palpable pulses in these patients is associated with higher incidence of multiple organ failure (MOF) and in-hospital mortality. METHODS: A retrospective cohort study included 87 patients with acute type A aortic dissection, who were admitted via an emergency department between December 1991 and December 1999 for emergency surgery. Impending cardiac tamponade (with palpable pulses) and severe cardiac tamponade (without palpable pulses) were recorded and patients were followed for occurrence of MOF and/or in-hospital mortality. RESULTS: Impending cardiac tamponade with palpable pulses was diagnosed in 33 patients (38%), signs of severe cardiac tamponade without palpable pulses were found in seven patients (8%). MOF occurred in 41 patients (47%); 32 patients (37%) died during the present stay, all of them had MOF. Preoperative severe cardiac tamponade without palpable pulses was associated with a significantly increased risk for poor outcome (odds ratio (OR)=16.1, 70% confidence interval (CI) 4.8-71.7, P=0.04), particularly preoperative death (n=6 of 7). Impending cardiac tamponade with palpable pulses (OR=1.6, 70% CI 0.8-3.3, P=0.2) was not associated with the occurrence of MOF/death. Hemodynamic shock (OR=6.5, 70% CI 3.0-13.9, P=0.01) was also associated with poor outcome. CONCLUSION: Patients with acute type A aortic dissection and signs of preoperative cardiac tamponade without palpable pulses had a 16-fold increased risk for poor outcome, particularly preoperative death. In contrast, cardiac tamponade with palpable pulses was not associated with increased frequency of MOF/in-hospital mortality.

Acute Disease↗
PubMed1999

Diagnosis and management of cardiac tamponade in the era of echocardiography.

Cardiac tamponade is a life-threatening condition. Accurate diagnosis and prompt intervention are necessary. Classically, clinical features of tamponade include pulsus paradoxus, tachycardia, increased jugular venous pressure, and hypotension. With the advent of echocardiography, confirmation of an effusion and accurate assessment of its hemodynamic impact can be achieved, frequently in the absence of overt clinical manifestations. The decision regarding treatment and timing of intervention must take into account the clinical presentation and echocardiographic findings, along with careful weighing of risks and benefits to the individual patient. Echocardiographically guided pericardiocentesis is the best available therapy for initial management of cardiac tamponade. It is simple, safe, and effective for removing pericardial fluid and reversing hemodynamic instability, and the use of a pericardial catheter for extended drainage has been associated with significant reduction in recurrence of fluid accumulation.

Cardiac Tamponade↗
PubMed1983

Hydrodynamic compression of the right atrium: a new echocardiographic sign of cardiac tamponade.

The relationship of right atrial inversion, a previously undescribed cross-sectional echocardiographic sign, to the presence of cardiac tamponade was examined. We studied 127 patients with moderate or large pericardial effusions. Cardiac tamponade was present in 19 and absent in 104. Four patients with equivocal tamponade were excluded from analysis. Right atrial inversion was present in 19 of 19 patients with cardiac tamponade and 19 of 104 without cardiac tamponade (sensitivity, 100%; specificity, 82%; predictive value, 50%). The degree of inversion as quantitated by the area-corrected curvature did not improve the ability to discriminate between patients with and without cardiac tamponade. However, consideration of the duration of inversion by the right atrial inversion time index (duration of inversion/cardiac cycle length) and an empirically derived cut-off of 0.34 did improve the specificity and predictive value (100% and 100%, respectively) without a significant loss of sensitivity (94%). We conclude that right atrial inversion, particularly if prolonged, is a useful echocardiographic marker of cardiac tamponade that may be of particular diagnostic value when the clinical picture is unclear.

Adolescent↗
PubMed1996

The diagnosis of pericardial effusion and cardiac tamponade by 12-lead ECG. A technology assessment.

OBJECTIVE: This study was designed to determine the diagnostic value of 12-lead ECG for pericardial effusion and cardiac tamponade. DESIGN: Cross-sectional study. SETTING: University hospital. PATIENTS: Hospitalized patients with and without pericardial effusion and cardiac tamponade. MEASUREMENTS AND RESULTS: In a blinded manner, we reviewed 12-lead ECGs from 136 patients with echocardiographically diagnosed pericardial effusions (12 of whom had cardiac tamponade) and from 19 control subjects without effusions. We examined the diagnostic value of three ECG signs: low voltage, PR segment depression, and electrical alternans. We found that all three ECG signs were specific but not sensitive for pericardial effusion (specificity, 89 to 100%; sensitivity, 1 to 17%) and cardiac tamponade (specificity, 86 to 99%; sensitivity, 0 to 42%). None of the ECG signs were associated with pericardial effusions of all sizes, but low voltage was associated with large and moderate pericardial effusions (odds ratio = 2.5; 95% confidence interval [CI] = 0.9 to 6.5; p = 0.06) and with cardiac tamponade (odds ratio = 4.7; 95% CI = 1.1 to 21.0; p = 0.004). In contrast, PR segment depression was associated only with cardiac tamponade (odds ratio = 2.0; 95% CI = 1.0 to 4.0; p = 0.05), while electrical alternans was not associated with either pericardial effusion or cardiac tamponade. CONCLUSIONS: Low voltage and PR segment depression are ECG signs that are suggestive, but not diagnostic, of pericardial effusion and cardiac tamponade. Because these ECG findings cannot reliably identify these conditions, we conclude that 12-lead ECG is poorly diagnostic of pericardial effusion and cardiac tamponade.

Cardiac Tamponade↗
PubMed2004

Central venous catheters and cardiac tamponade in preterm infants.

OBJECTIVE: To determine the incidence of cardiac tamponade related to peripherally inserted central catheters in newborns weighing less than 1,500 g during the past 8 years and to provide guidelines in order to avoid death due to this complication. DESIGN: Retrospective case review. SETTING: Tertiary level neonatal intensive care unit. PATIENTS AND PARTICIPANTS: Retrospective study of a total of 280 peripherally inserted central catheters positioned in 258 preterm newborns. MEASUREMENTS AND RESULTS: Five cardiac tamponades were observed, giving an incidence of 1.8%. Data from our cases included clinical presentation and outcome, biochemical evaluation of pericardial fluid, days until diagnosis, central catheters characteristics, insertion site and tip placement site. INTERVENTION: Two of the infants did not respond to resuscitation measures including cardiac massage and the administration of epinephrine. Post-mortem examination revealed the intrapericardial accumulation of protein and lipid alimentation solution. The other three patients were successfully resuscitated by timely pericardiocentesis. All five infants had routinely performed serial radiographs and cardiac color Doppler ultrasonography that showed correct catheter tip placement. CONCLUSIONS: The incidence of cardiac tamponade could be reduced by following specific guidelines. The possibility of tamponade must be kept in mind during the resuscitation of any preterm infant with a peripherally inserted central catheter in place who develops symptoms of shock or sudden bradycardia. Our experience shows that even preterm infants with cardiac tamponade can be successfully resuscitated by timely pericardiocentesis in most cases.

Cardiac Tamponade↗
PubMed1982

Cardiac tamponade secondary to chylopericardium following cardiac surgery: case report and review of the literature.

Only four instances of isolated chylopericardium following cardiac operation have been reported previously. We encountered this complication in a young patient who was operated on for infundibular pulmonary stenosis. The etiology appears to be related to a combination of intraoperative lymphatic injury and catheter-related subclavian vein thrombosis, the latter potentially elevating pressure within the thoracic duct and thereby resulting in an accumulation of chyle within the pericardial space. Therapy for this problem usually includes partial pericardiectomy with or without ligation of the thoracic duct.

Adult↗
PubMedDate not supplied

Cardiac tamponade after removal of atrial intracardiac monitoring catheters in a pediatric patient: case report.

The incidence of cardiac tamponade after cardiac surgery is reported as ranging from 0.04% to 7%. Although a relatively infrequent complication, tamponade is associated with significant morbidity and mortality. Reports of tamponade after pediatric cardiac surgery are few and generally associated with postcardiotomy syndrome or, less commonly, removal of left atrial or pulmonary artery catheters after surgery. A case is presented of cardiac tamponade in a pediatric patient resulting from removal of a direct atrial and a pulmonary artery catheter after cardiac surgery. The pathophysiology of cardiac tamponade is reviewed and the increased risk for pediatric patients is outlined. The case review is conducted in the context of existing policies in the reporting institution and recommendations for practice are discussed.

Cardiac Catheterization↗
PubMed2004

Aetiology and management of acute cardiac tamponade.

OBJECTIVE: To review current concepts in the aetiology and management of patients with cardiac tamponade. DATA SOURCES: A review of articles reported on acute cardiac tamponade. SUMMARY OF REVIEW: Cardiac tamponade is defined as a haemodynamically significant cardiac compression caused by pericardial fluid. The fluid may be blood, pus, effusion (transudate or exudate) or air and treatment involves correction of the cardiac diastolic restriction by removing pericardial fluid during either pericardiocentesis or thoracotomy. Pericardiocentesis is usually performed for urgent management of an acute tamponade. A thoracotomy is required when a tamponade exists following coronary artery bypass grafting, cardiac rupture, penetrating or closed cardiac trauma and aortic dissection or where a pericardial clot is likely. Removal of pericardial fluid by percutaneous catheterisation of the pericardial sac traditionally uses the subxiphoid 'blind' approach., However, pericardial aspiration is often currently performed under transthoracic echocardiographic guidance with the commonest site of needle entry being on the chest wall at or near the apex and the needle directed perpendicular to the skin. The pericardial fluid is drained using an indwelling 'pigtail' catheter, preferably with close monitoring of the pulmonary artery wedge pressure, as rapid removal of large volumes of pericardial fluid (> 500 mL) may result in a 'decompressive syndrome' causing pulmonary oedema. The fluid is sent for culture and Gram-stain and analysed for glucose, protein, lactate dehydrogenase, haemoglobin and white cell count. If appropriate the fluid is also analysed for amylase, and cholesterol and sent for cytology, serology and parasitic studies and viral, mycobacterial and fungal cultures. CONCLUSIONS: Cardiac tamponade may present as an acute or subacute syndrome of elevated central venous pressure and hypotension. Pericardiocentesis using echocardiographic guidance and right heart catheter control is often the method of choice for acute removal of fluid.

Journal Article↗
PubMed1987

Cardiac tamponade resulting from pneumopericardium: case report and implications for the critical care nurse.

Pneumopericardium resulting in cardiac tamponade may be caused by a variety of phenomena. The onset of cardiac tamponade can indicate the presence of a rare underlying condition. As a rare complication of mechanical ventilation and PEEP, our patient experienced pneumopericardium that resulted in cardiac tamponade. Perhaps the most crucial therapy of all is astute critical care nursing assessment of patients at risk of developing the life-threatening complication of cardiac tamponade. All critical care nurses should know the signs and symptoms of cardiac tamponade. Through accurate data collection, frequent monitoring, and immediate referral to the critical care team for medical diagnosis and treatment, a patient's death can be prevented.

Adenocarcinoma↗
PubMed1992

[Cardiac tamponade: clinical review of 53 cases].

BACKGROUND: To describe the clinical features and prognosis of the patients with cardiac tamponade admitted in the coronary care unit. METHODS: Analysis the clinical data, etiology, treatment, and short term outcome of fifty three patients presenting with cardiac tamponade that required pericardiocentesis. RESULTS: Neoplasm (21 cases) and idiopathic pericarditis (10 cases) were the most frequent causes of cardiac tamponade. In forty four patients an haemorrhagic fluid was obtained. Neoplastic pericardial fluid showed a higher haematocrit than the rest (18 +/- 8% vs 7 +/- 5%, p less than 0.01). Recurrence of tamponade occurred in all but one neoplastic patients, and was early (less than 48 h) in 18 patients. Twenty seven patients underwent pericardiectomy, and recurrence was the most frequent indication (18 cases). Overall in-hospital mortality was 26%. Ten out of 14 deaths occurred in neoplastic patients and 2 deaths after myocardial perforation related to temporary pacemaker. No patient with idiopathic or post-pericardiotomy cardiac tamponade died. CONCLUSIONS: Short term outcome and prognosis in patients with cardiac tamponade mainly depends on the etiology. A high rate of early recurrence and death characterize the malignant cardiac tamponades.

Adult↗
PubMed2005

Cardiac tamponade associated with a peripheral vein central venous catheter.

We present a case of cardiac tamponade associated with placement of a central venous catheter (CVC) via a peripheral vein in a 14-year-old girl with idiopathic scoliosis undergoing corrective surgery. A number of complications have been described in association with CVC misplacement. Sporadic cases of cardiac tamponade from this have been reported, but the actual incidence is unknown. Death from cardiac tamponade attributed to CVCs ranges from 65 to 100%. In our patient, cannulation of the pericardiophrenic vein was probably the cause of cardiac tamponade, based on radiological evidence that the initial location of the catheter was near the right atrium and possibly at the outlet of the pericardiophrenic vein. The catheter could have advanced into the vein and then to the pericardial sac with postural changes. The acute clinical course of cardiac tamponade in our patient had potentially lethal hemodynamic repercussions. The main diagnostic test for this condition is echocardiography and the only effective treatment is drainage of the pericardial effusion. Echocardiography should be performed before pericardiocentesis except in life-threatening situations or high clinical suspicion. Although they are rare, it is important to be aware of the potential for CVC complications.

Adolescent↗