Prevalence of pericardial effusion in systemic diseases / Prevalencia de derrame pericárdico en enfermedades sistémicas

Abstract Introduction: The presence of 50 ml of fluid or more in the pericardial sac is known as pericardial effusion. Objective: To determine the prevalence of pericardial effusion in patients with systemic diseases. Method: Echocardiographic studies performed at the National Medical Center Siglo XXI Specialty Hospital Cardiology Department between 2006 and 2016 were reviewed. According to Weitzman's criteria, pericardial effusion was classified as mild, < 10 mm, moderate, 10 to 20 mm and severe, > 20 mm. Results: In total, 10,653 studies were reviewed; the prevalence of pericardial effusion was 3.5 % (380), in 209 women (55 %, 45.9 ± 19.0 years) and 171 men (45 %, 41.9 ± 18.5 years). Etiology was uremic in 227 (59.7 %), lymphatic drainage reduction in 73 (15.8 %), autoimmune diseases in 30 (7.9 %), neoplastic in 26 (6.8 %), infectious in 19 (5 %), idiopathic in 14 (3.7 %), hypothyroidism in two (0.5 %), iatrogenic in one (0.3 %) and post-infarction in one (0.3 %). Severity was mild in 87 (22.9 %), moderate in 147 (38.7 %) and severe in 146 (38.4 %). Conclusions: The prevalence of pericardial effusion was 3.5% in patients with systemic diseases.

Tamponamento cardíaco por cateter central de inserção periférica em prematuros: papel da ultrassonografia à beira do leito e abordagem terapêutica / Cardiac tamponade by peripherally inserted central catheter in preterm infants: role of bedside ultrasonography and therapeutic approach

RESUMO Objetivo: determinar a incidência de derrame pericárdico com tamponamento cardíaco em recém-natos prematuros em uma unidade de terapia intensiva pediátrica, com ênfase na relação entre o derrame pericárdico e a inserção de cateter central de inserção periférica, e avaliar o papel da ultrassonografia à beira do leito na abordagem desses casos. Métodos: análise retrospectiva dos pacientes internados em unidade de terapia intensiva pediátrica, entre julho de 2014 e dezembro de 2016, que apresentaram derrame pericárdico com repercussão hemodinâmica, avaliados por ultrassonografia. Resultados: foram estudados 426 pacientes admitidos na unidade neonatal de cinco leitos, com realização 285 ultrassonografias à beira do leito. Foram encontrados seis casos de derrame pericárdico, sendo quatro casos com choque obstrutivo e necessidade de realização de drenagem pericárdica, sem mortalidade relacionada ao procedimento e com melhora hemodinâmica em todos os pacientes após o procedimento. A incidência de derrame pericárdico foi de 2,4 casos por ano. Conclusão: a incidência de derrame pericárdico é baixa em neonatos, porém o diagnóstico precoce é fundamental devido à alta morbimortalidade, especialmente nos casos de instalação abrupta. Todos os casos foram diagnosticados pela ultrassonografia à beira do leito, demonstrando sua importância no rastreio desses casos, especialmente em nos quadros de choque de etiologia incerta e neonatos com instabilidade hemodinâmica de início súbito que estão em uso de acesso venoso central.

ABSTRACT Objective: to determine the incidence of pericardial effusion with cardiac tamponade in preterm infants in a pediatric intensive care unit, with emphasis on the relationship between pericardial effusion and peripherally inserted central catheter, and to evaluate the role of bedside ultrasound in approaching these cases. Methods: we conducted a retrospective analysis of patients admitted to a pediatric intensive care unit between July 2014 and December 2016, who presented pericardial effusion with hemodynamic repercussion, evaluated by ultrasonography. Results: we studied 426 patients admitted to the five beds of the neonatal unit. In the period, there were 285 bedside ultrasound exams. We found six cases of pericardial effusion, four of which with obstructive shock and need for pericardial drainage. There was no procedure-related mortality, and all patients evolved with hemodynamic improvement after the procedure. The incidence of pericardial effusion was 2.4 cases per year. Conclusion: the incidence of pericardial effusion is low in neonates, but early diagnosis is fundamental due to high morbidity and mortality, especially in cases of abrupt onset. All cases were diagnosed by bedside ultrasonography, demonstrating its importance in the screening of these cases, especially in shocks of uncertain etiology and neonates with sudden onset hemodynamic instability who are using central venous access.

Análisis de las características clínicas, ecocardiográficas, microbiológicas y citopatológicas de derrames pericárdicos en un hospital de tercer nivel de atención / Analysis of clinical, echocardiographic, microbiological and cytopathological characteristics of pericardial effusions in a tertiary hospital care

Objetivo: Conocer la prevalencia, las causas, los hallazgos clínicos, ecocardiográficos, microbiológicos y citopatológicos de pacientes con derrame pericárdico. Métodos: Estudio observacional, retrospectivo, transversal y analítico. Se analizaron expedientes clínicos de pacientes que reciben pericardiocentesis durante un periodo de 5 años. Se empleó estadística descriptiva, con medidas de tendencia central y de dispersión para el análisis. Resultados: La prevalencia de derrame pericárdico fue del 1.1%. Predominó en mujeres (60.4%) y se observó una media de edad de 49 años. La principal causa asociada fue neoplásica, con un 32.1%, seguida de la idiopática y reumatológica con un 27.4 y 10.4%, respectivamente. Se presentó taponamiento cardiaco en un 27.1%, siendo la disnea y la presencia de tonos cardiacos apagados los datos clínicos más comunes. El colapso auricular y ventricular derechos se presentaron en el 84.9 y 75.5%, respectivamente. El estudio citopatológico de líquido pericárdico presentó un mayor rendimiento diagnóstico en el estudio de derrames asociados a neoplasias, mostrando una sensibilidad del 54%, una especificidad del 95%, un valor predictivo positivo del 85% y un valor predictivo negativo del 81%. Conclusiones: La prevalencia de derrame pericárdico en un hospital de tercer nivel fue del 1.1%, predominando la etiología neoplásica. El colapso auricular y ventricular derechos son los hallazgos ecocardiográficos más comunes en la presencia de derrame pericárdico moderado o severo. El estudio citopatológico tiene una alta especificidad ante la sospecha de causa neoplásica.

Objective: To determine the prevalence, etiology, clinical, echocardiographic, microbiological and cytopathological characteristics of patients with pericardial effusion. Methods: Observational, retrospective, cross-sectional analytical study. We reviewed medical records of patients undergoing pericardiocentesis for a 5 years period. We used descriptive statistics, measures of central tendency and dispersion for analysis. Results: The prevalence of pericardial effusion was 1.1%. Predominant in women (60.4%) and there was a mean age of 49 years. The main causes were neoplastic 32.1%, idiopathic 27.4% and rheumatological 10.4%. A percentage of 27.1 had cardiac tamponade whereas dyspnea and muffled heart sounds were the most common clinical data. The right atrial and ventricular collapse occurred in 84.9 and 75.5%, respectively. The pericardial fluid cytology yielded better in neoplastic causes a sensitivity of 54%, specificity 95%, positive predictive value 85% and negative predictive value 81%. Conclusions: The prevalence of pericardial effusion in a tertiary care hospital was 1.1%, the main cause was neoplastic. In the evaluation of moderate or severe pericardial effusion we found that right atrial and ventricular collapses were the most common echocardiographic findings. The cytopathological study had a high specificity for the diagnosis of neoplasia.

Plasmodium Vivax Malaria Complicated by Pericardial Effusion.

We describe herein an unusual and sole cardiac complication of pericardial effusion in a case of plasmodium vivax malaria.

Procedimentos invasivos nas afecções pericárdicas / Surgical approach to pericardial diseases

Nesta revisão, são descritas as principais afecções do pericárdio que levam à necessidade de tratamento cirúrgico. São abordadas as pericardites, o derrame pericárdico, com ou sem tamponamento, e o piopericárdio. São descritos os sinais clínicos e os exames mais adequados para o diagnóstico correto de cada uma dessas entidades, assim como as indicações cirúrgicas relativas a cada doença, e seus resultados na evolução desses pacientes.

Characterisation of fowl adenoviruses from chickens affected with infectious hydropericardium during 1994-1998 in India.

In the present study characterisation has been done for six group I fowl adenoviruses (FAV) isolated from outbreaks of infectious hydropericardium (IHP) of chickens that occurred in different states/regions of India during the years 1994-98. These six viruses were identified as FAV serotype 4 by virus neutralisation and restriction endonuclease analyses. Antigenic analyses of the viruses revealed close relationship (R-values 0.93-0.96). Under the experimental conditions, we have been able to induce IHP using FAV serotype 4 isolate AD: 411 and were also able detect FAV antigens in myocardial tissues by immunofluorescence assay (a new observation), an indication that IHP causing FAV serotype 4 strain replicate in myocardial tissue. Restriction endonuclease analysis of the viral genomes (approximately 46 Kb), using Hind III, Sma I, Xba I, Bam HI, Pst I and Dra I produced identical genetic profiles. Pst I and Bam HI profiles for these six vitus isolates were identical to those published earlier for an IHP causing Pakistani FAV serotype 4 isolate KR31. The identical genetic profiles of viruses, chronology of the outbreaks of IHP in Pakistan during 1989 onward and later in Jammu and Kashmir, India (1994), suggest that FAV serotype 4 isolates involved in outbreaks of IHP in India had probably spread from Pakistan. In order to prevent further spread and economic losses due to IHP in India, based on the antigenic relatedness data in this paper, any one of the six studied FAV serotype 4 isolates can be used as a candidate for mass production of CEH culture based killed vaccine.

Pericardial effusion as a cause of morbidity in patients on maintenance hemodialysis: is it preventable?

Cardiovascular diseases are the cause for 45 percent mortality and 20 percent morbidity in haemodialysis [HD] patients. Pericardial effusion [PE] accounts for 03 - 04 percent of all deaths in HD patients as a result of tamponade, arrhythmias or- heart failure. This study aims to find out the prevalence and precipitating factors for PE in haemodialysis patients. Fifty five patients were identified for echo-cartographic assessment on the basis of signs and symptoms suggestive of PE i.e., hypotension during dialysis, dyspnea, globular heart in chest x-ray, raised JVP, soft heart sounds and low voltage EGG. A matched controlled group of 55 patients for age, sex, dialysis schedule, cause of ESRD and dialysis bath, was also studied echocardiographically. Pericardial Effusion was detected in 12 patients [10.9 percent], 10 [83.3 percent] were on 2/week and only two on 3/week dialysis. Of these 75 percent were non-compliant in fluid intake and 58.3 percent were irregular in treatment. The morbidity of PE in study group [18.2 percent] is significantly higher as compared to controls [3.6 percent] [P = <0.05]. No correlation was found between development of PE and high iPTH and low albumin levels. Ten patients with mild PE responded to vigorous dialysis. Two patients developed cardiac tamponade needing pericardiocentesis. We have identified 2/week dialysis [inadequate dialysis dose], acetate bath and fluid and dialysis non-compliance as factors contributing to development of PE in HD patients