Taponamiento Cardiaco: cuando el corazón se encuentra bajo presión / Cardiac tamponade: when the heart is under pressure

BACKGROUND: Cardiac tamponade is a medical emergency that occurs when fluid accumulates in the pericardial space, its prompt diagnosis and treatment can prevent a fatal outcome. OBJECTIVES: We describe a case of cardiac tamponade in a medicine Ward and its subsequent resolution. CLINICAL CASE: 56-year-old male patient with dyspnoea and edematous síndrome, managed with partial response depletive therapy. Echocardiographic study reveals a large pericardial effusion with signs of cardiac tamponade. Inmediate management with ultrasound-guided pericardiocentesis and subsequent surgical resolution. DISCUSSION: The knowledge of the clinical-hemdynamic manifestations and their subsequent pathophysiological background are important in the diagnostic suspicion and management considerations. Echocardiography is a critical component for the final diagnosis, since given its sensitivity and specificity it allows to complete the characterization of the pericardial effusion. In addition, it contributes to reducing the morbidity associated with its drainage.

Perfuração subaguda de ventrículo direito por cabo-eletrodo de choque de cardioversor-desfibrilador implantável / Subacute right ventricular perforation by shock lead of implantable cardioverter defibrillator

Relatamos o caso de paciente portador de cardiomiopatia hipertrófica, submetido a implante de cardioversor-desfibrilador implantável, que evoluiu, na primeira semana de pós-operatório, com dor torácica, síncope e choque cardiogênico. À ecocardiografia transtorácica, diagnosticou-se derrame pericárdico e perfuração do ventrículo direito pelo cabo-eletrodo de choque. Foi submetido a toracotomia de urgência e rafia do miocárdio com resolução do quadro. As possíveis razões desse desfecho são discutidas, comparativamente a outros casos na literatura

We report the case of a patient with hypertrophic cardiomyopathy, submitted to an implantable cardioverter defibrillator implant who developed chest pain, syncope, and cardiogenic shock in the first post-operative week. Pericardial effusion and right ventricular perforation by shock lead were diagnosed by transthoracic echocardiography. The patient underwent emergency thoracotomy and myocardial raffia with resolution of the condition. We discuss the possible reasons for this outcome and compare it to other cases in the literature

Diagnosis of cardiac tamponade with transesophageal echocardiography following the induction of anesthesia for suspected testicular torsion.

Transesophageal echocardiography (TEE) is a valuable tool for evaluating hemodynamic instability in patients under general anesthesia. We present the case of a 28‑year‑old man who presented with complaints of testicular pain concerning for testicular torsion. After induction of general anesthesia for scrotal exploration and possible orchiopexy, the patient developed severe and persistent hypotension. Using intraoperative TEE, the diagnosis of pericardial tamponade was made, and an emergent pericardial window was performed.

Taponamiento cardiaco posterior a intervención coronaria percutánea / Cardiac tamponade after percutaneous coronary intervention

La perforación coronaria es una rara complicación de la intervención coronaria percutánea, pero puede desencadenar un taponamiento cardiaco potencialmente letal. Esta complicación ha sido reportada en 0,1 -3.0 por ciento de los procedimientos. Este reporte describe un caso de hemopericardio y taponamiento cardiaco posterior a una intervención percutánea en un paciente anticoagulado con warfarina y con síndrome coronario agudo sin elevación del segmento ST. Una rápida intervención aseguró una excelente evolución clínica del paciente.

Coronary perforation is a rare complication of percutaneous coronary intervention, but can trigger potentially lethalcardiac tamponade. This complication has been reported in 0,1 – 3,0 % of procedures. This report describes a case ofhemopericardium and cardiac tamponade after percutaneous intervention in an warfarin anticoagulated patient withacute coronary syndrome without ST segment elevation. A rapid intervention ensured an excellent clinical evolution ofthe patient.

Taponamiento cardiaco como primera manifestación de una neoplasia de pulmón / Cardiac tamponade as first manifestation of a lung neoplasm

INTRODUCCIÓN: En el taponamiento cardiaco existe restricción del llenado del corazón debido a un incremento de la presión de la cavidad pericárdica secundario a derrame pericárdico. Este aumento puede alcanzar valores que lleguen a superar las presiones fisiológicas de las cavidades derechas, comprometiendo así el llene de éstas, afectando secundariamente la precarga del ventrículo izquierdo. PRESENTACIÓN DEL CASO: Paciente de 52 años, sexo masculino, con antecedentes de tabaquismo y diabetes mellitus tipo 2, que consultó al servicio de urgencias del centro asistencial Víctor Ríos Ruiz de Los Ángeles por cuadro caracterizado por dolor cólico epigástrico, asociado a nauseas, vómitos, distensión abdominal, coluria, oliguria, anorexia, constipación, astenia, adinamia y malestar general. Es hospitalizado en el servicio de cirugía por sospecha de colecistitis aguda, se realiza ecografía abdominal donde se pesquizó líquido libre perihepático y periesplénico, y aumento del calibre de la vena cava inferior con derrame pleural bilateral. Comenzó con hipotensión, pulso paradojal e ingurgitación yugular, por lo que es trasladado a UCI donde la ecocardiografía confirmó taponamiento cardiaco. Se realizó pericardiocentésis y estudio del líquido, que muestra células de aspecto neoplásico. Se realizó tomografía axial computarizada (TAC) encontrándose lesión sólida en lóbulo pulmonar inferior izquierdo, nódulo en lóbulo medio y múltiples adenopatías mediastínicas e hiliares bilaterales. DISCUSIÓN: El derrame pericárdico maligno suele presentarse como taponamiento cardiaco, siendo la causa más frecuente el cáncer de pulmón. El pronóstico de un derrame pericárdico en contexto de cáncer pulmonar es más bien ominoso, llegando a ser menor a los 3 meses de vida.

INTRODUCTION: In cardiac tamponade, there is a filling restriction of the heart due to increased pressure of the pericardial cavity secondary to pericardial effusion. Pressure can reach values greater than that of the right heart cavities, compromising their filling, and, secondarily, affecting the preload of the left ventricle. CASE REPORT: A 52-year old male, with type 2 diabetes mellitus, consulted to the emergency department of Víctor Ríos Ruiz Hospital of Los Angeles, Chile for epigastric colic pain, nausea, vomiting, abdominal distention, choluria, oliguria, anorexia, constipation, asthenia, adynamia and malaise. He is admitted to the surgery ward on the suspicion of acute cholecystitis. Abdominal ultrasound showed perihepatic and perisplenic free fluid and increased caliber of the inferior vena cava, associated with bilateral pleural effusion. Hypotension, paradoxical pulse and jugular engorgement developed, so he is transferred to the ICU where echocardiography confirmed cardiac tamponade. Pericardiocentesis was performed, which showed malignant cells on microscopy. A computerized tomography (CT scan) showed a solid mass in the left inferior lung lobe, a nodule in the middle lobe and multiple mediastinal and hiliar bilateral lymphoadenopaties. DISCUSSION: Malignant pericardial effusion commonly presents as cardiac tamponade, being the lung cancer its main etiology. The prognosis of pericardial effusion in lung cancer is rather ominous, with an overall survival of less than 3 months.

Cardiac Tamponade Complicated by Acupuncture: Hemopericardium due to Shredded Coronary Artery Injury

We report a case of 62-year-old man with cardiac tamponade due to coronary artery injury after acupuncture into the substernum. After resuscitation of cardiac arrest, we performed emergent pericardiocentesis. Nevertheless, the cardiac arrest recurred, and the emergent operation on cardiopulmonary bypass was performed. We identified hemopericardium due to shredded acute marginal branch of right coronary artery, and it was ligated leading to termination of bleeding. The patient was discharged without any other complications.

Plasma Cell Type of Castleman's Disease Involving Renal Parenchyma and Sinus with Cardiac Tamponade: Case Report and Literature Review

Castleman's disease is an uncommon disorder characterized by benign proliferation of the lymphoid tissue that occurs most commonly in the mediastinum. Although unusual locations and manifestations have been reported, involvement of the renal parenchyma and sinus, and moreover, manifestations as cardiac tamponade are extremely rare. Here, we present a rare case of Castleman's disease in the renal parenchyma and sinus that also accompanied cardiac tamponade.

Cardiac tamponade: A small case series.

The term cardiac tamponade describes a condition in which the heart is compressed by an excess of fluid in the pericardial space, with resulting abnormalities of cardiac function. Cardiac tamponade is a rare cause of sudden death. It is difficult to diagnose both in living and dead. In dead diagnosis is difficult at autopsy in absences of external visible injury & in living person the symptoms of cardiac tamponade are non specific. The symptoms relate principally to the secondary circulatory embarrassment. We present the series of cases with cause of death as cardiac tamponade due to diseases & trauma. These cases demonstrate that focus should always to be given to entire vital organs like heart and possibility of tamponade should be kept in mind.

Pericardial tamponade after left posterolateral thoracotomy for left upper lobectomy for pulmonary aspergilloma.

Pericardial tamponade limits diastolic filling of the heart; therefore, a high venous pressure is required to fill the ventricle. In presence of cardiac tamponade, therapeutic agents and manoeuvres that results in venodilation or vasodilation can severely compromise diastolic filling of the heart and might result in rapid cardiac decompensation. Equalization of central venous pressure and pulmonary artery diastolic pressure or equalization of pressures in all four chambers during diastole confirms cardiac tamponade. Transthoracic echocardiography can detect the site of tamponade and assist in pericardiocentesis. We describe acute pericardial tamponade in a young man who underwent left posterolateral thoracotomy for left upper lobectomy. Intraoperatively, mobilization of the left upper lobe was frequently associated with hypotension. Postoperatively, the patient suffered two more episodes of hypotension. The episodes of hypotension were attributed to surgical manipulation and epidural blockade. Hemodynamics normalized after discontinuing epidural infusion, volume resuscitation and lobectomy. On third postoperative day, the patient developed cardiovascular collapse; arterial blood pressure and central venous pressure were 70/50 and 12 mmHg. Investigations showed haziness of left lung, and severe respiratory acidosis. On opening of the left thoracotomy wound, pericardial tamponade was diagnosed. A pericardial window was created and tamponade was released with that the hemodynamics normalized. Episodes of unexplained hypotension after left upper lobectomy suggest a cardiac etiology and acute pericardial tamponade is a possibility which should be released immediately otherwise it can result in fatal outcome.

Pericardite aguda e crônica / Acute and chronic pericarditis

A pericardite é a forma mais comum das doenças do pericárdio e pode se apresentar nas formas aguda e crônica. Frequentemente é idiopática e de evolução benigna. Quando não, as causas mais comuns são tuberculose, neoplasias malignas e doenças autoimunes. O diagnóstico clínico requer a presença de dor precordial típica, atrito pericárdico, elevação difusa do segmento ST e derrame pericárdico. Os exames laboratoriais incluem: ECG, ecocardiograma, RX do tórax e marcadores de inflamação e necrose miocárdica Procedimentos adicionais e internação devem ser considerados para o pacientes de maior risco. Os marcadores de risco são febre >38ºC, evolução subaguda, derrame pericárdico volumoso ou tamponamento cardíaco e ausência de resposta ao tratamento com anti-inflamatórios. O tratamento da pericardite deve ser focar a causa específica, quando identificável. Genericamente, usa-se aspirina ou anti-inflamatórios não hormonais para os casos de etiologia viral ou idiopáticos. A colchicina pode ser útil como droga adicional nos casos recorrentes. A pericardiocentese está indicada nos pacientes com tamponamento cardíaco, quando há chance elevada de tuberculose, pericardite purulenta ou neoplasia. A pericardiectomia fica reservada para os casos de pericardite constrictiva crônica.

Pericarditis is the most common form of pericardial diseases and most of the cases are idiopathic and and follow a benign course. Major nonidiopathic etiologies include tuberculosis, neoplasia and autoimmune diseases.The clinical diagnosis is confirmed when the following criteria are present: typical chest pain, pericardial friction rub, widespread ST-segment elevation, and pericardial effusion. Tests for pericarditis include ECG, echocardiogram, chest radiography and inflammation markers. High-risk patients need tests for etiology search and hospitalization. High-risk patients present fever >38oC, a subacute course, large pericardial effusion or cardiac tamponade and/or failure of antiinflammatory drugs.Treatment should target the specific etiology, if known. Generically, aspirin or a non-steroid anti-inflammatory drug is used for treatment of viral and idiopathic pericarditis. Colchicine is recommended as adjunct therapy for recurrent events. Pericardiocentesis is indicated for cardiac tamponade, high suspicion of tuberculosis, purulent pericarditis or neoplasia. Pericardiectomy is recommended for persistent constriction.

A Case of Behcet's Disease with Pericarditis, Thrombotic Thrombocytopenic Purpura, Deep Vein Thrombosis and Coronary Artery Pseudo Aneurysm

Behcet's disease with concomitant thrombotic thrombocytopenic purpura (TTP), coronary artery stenosis and coronary artery pseudo aneurysm is rare. Here we report a case of Behcet's disease with several cardiovascular complications, namely: pericarditis, deep vein thrombosis (DVT), TTP, coronary artery stenosis, and a coronary artery pseudo aneurysm. A 37-year-old female presented with sudden dyspnea and syncope at our emergency room and underwent pericardiectomy and pericardial window formation for the diagnosis of cardiac tamponade with acute hemorrhagic pericarditis. Thereafter, TTP and DVT complicated her illness. After confirmation of Behcet's disease on the basis of a history of recurrent oral and genital ulcers and erythema nodosum, remission was achieved after treatment with methylprednisolone pulse therapy, colchicine, catheter directed thrombolysis and thrombectomy. However, whilst maintaining anticoagulation therapy, a newly developed pericardial aneurysmal dilatation was noted on follow-up radiologic evaluation. Further evaluation revealed right coronary artery stenosis and a left coronary artery pseudo aneurysm; these additional problems were treated with the nonsurgical insertion of an endovascular graft stent . At the time of writing three months later after stent insertion, the aneurysm has continued to regress and no additional complications have intervened with combined immunosuppressive therapy.

Taponamiento cardiáco por hipotiroidismo: descripción de 2 casos / Cardiac tamponade by bypothyroidism: description of 2 cases

Rara vez el derrame pericárdico en el hipotiroidismo evoluciona al taponamiento cardíaco, complicación que es mortal si no se diagnostica y trata a tiempo. En este artículo describimos dos singulares casos y discutimos aspectos importantes de la fisiopatogía, diagnóstico y manejo de esta enfermedad.