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Internal and Emergency Medicine Oct 2021Pericardial effusion can dangerously precipitate patient's hemodynamic stability and requires prompt intervention in case of tamponade. We investigated potential... (Observational Study)
Observational Study
Pericardial effusion can dangerously precipitate patient's hemodynamic stability and requires prompt intervention in case of tamponade. We investigated potential predictors of in-hospital mortality, a composite outcome of in-hospital mortality, pericardiocentesis-related complications, and the need for emergency cardiac surgery and all-cause mortality in patients undergoing percutaneous pericardiocentesis. This is an observational, retrospective, single-center study on patients undergoing percutaneous pericardiocentesis (2010-2019). We enrolled 81 consecutive patients. Median age was 71.4 years (interquartile range [IQR] 58.1-78.1 years) and 51 (63%) were male. Most of the pericardiocentesis were performed in an urgency setting (76.5%) for cardiac tamponade (77.8%). The most common etiology was idiopathic (33.3%) followed by neoplastic (22.2%). In-hospital mortality was 14.8% while mortality during follow-up (mean 17.1 months) was 44.4%. Only hemodynamic instability (i.e., cardiogenic shock, hypotension refractory to fluid challenge therapy and inotropes) was associated with in-hospital mortality at the univariate analysis (odds ratio [OR] 7.2; 95% confidence interval [CI] 1.76-29.4). Non-neoplastic/non-idiopathic etiology and hemodynamic instability were associated with the composite outcome of in-hospital mortality, need for emergency cardiac surgery, or pericardiocentesis-related complications (OR 5.75, 95% CI 1.65-20.01, and OR 5.81, 95% CI 2.11-15.97, respectively). Multivariate Cox regression analysis adjusted for possible confounding variables (age, coronary artery disease, and hemodynamic instability) showed that neoplastic etiology was independently associated with medium-term mortality (hazard ratio [HR] 4.05, 95% CI 1.45-11.36). In a real-world population treated with pericardiocentesis for pericardial effusion, in-hospital adverse outcomes and medium-term mortality are consistent, in particular for patients presenting with hemodynamic instability or neoplastic pericardial effusion.
Topics: Aged; Cardiac Tamponade; Female; Forecasting; Hospital Mortality; Humans; Male; Middle Aged; Pericardial Effusion; Pericardiocentesis; Retrospective Studies; Treatment Outcome
PubMed: 33616878
DOI: 10.1007/s11739-021-02642-x -
Cureus Oct 2023Minoxidil-induced pleuro-pericardial effusion is a diagnosis of exclusion after evaluation for other known causes of pericardial effusion. When complicated by cardiac...
Minoxidil-induced pleuro-pericardial effusion is a diagnosis of exclusion after evaluation for other known causes of pericardial effusion. When complicated by cardiac tamponade, prompt pericardiocentesis and discontinuation of minoxidil can be lifesaving. We report a rare case of minoxidil-induced pleuro-pericardial effusion with tamponade in a patient with end-stage renal disease (ESRD) on hemodialysis who improved with pericardiocentesis and drug withdrawal.
PubMed: 37927730
DOI: 10.7759/cureus.46416 -
Frontiers in Cardiovascular Medicine 2022This study aimed to analyze the characteristics of patients with pericardial effusion requiring pericardiocentesis and to evaluate the safety of pericardiocentesis...
OBJECTIVE
This study aimed to analyze the characteristics of patients with pericardial effusion requiring pericardiocentesis and to evaluate the safety of pericardiocentesis without discontinuation of anticoagulant or antiplatelet drugs.
METHODS
We performed a retrospective study of patients undergoing pericardiocentesis in our hospital between 2012 and 2022. Patients were categorized into the Antithrombotic Group if they had used any antiplatelet or anticoagulant drugs on the day of pericardiocentesis; otherwise they were categorized into the Non-antithrombotic Group. All procedures were performed by experienced cardiologists with echocardiographic guidance. Bleeding events were defined using the National Institutes of Health scale of adverse events.
RESULTS
A total of 501 consecutive patients were identified and 70 cases were under antithrombotic drugs (Antithrombotic Group). Patients in Antithrombotic Group were older, had more comorbidities, presented with lower platelet counts and prolonged activated partial thromboplastin time (all < 0.05). Malignancy was the most common etiology for pericardial effusion in both groups (28.6% in Antithrombotic Group and 54.7% in Non-antithrombotic Group) and tuberculosis was the second etiology in the Non-antithrombotic Group (21.9%), while procedure-related effusion (17.1%) accounted for the second cause in the Antithrombotic Group. Two patients in the Antithrombotic Group had mild oozing at the puncture site that resolved without interventions (2.9 vs. 0%, = 0.019), and no bleeding events higher than Grade 1 occurred in either group.
CONCLUSION
Although antiplatelet or anticoagulant drugs may put patients undergoing pericardiocentesis at theoretically higher risk of bleeding, our study demonstrated that they are not associated with increased major bleeding complications.
PubMed: 36211575
DOI: 10.3389/fcvm.2022.1013979 -
Indian Journal of Critical Care... May 2022Hypothyroidism is commonly associated with pericardial effusion, but it can be rarely complicated by cardiac tamponade. We report a case series of two patients who...
UNLABELLED
Hypothyroidism is commonly associated with pericardial effusion, but it can be rarely complicated by cardiac tamponade. We report a case series of two patients who presented with shortness of breath and distension of the abdomen, progressing to generalized edema. Each of them was found to have cardiac tamponade at presentation and eventually diagnosed with hypothyroidism. They were managed by urgent pericardiocentesis followed by intermittent drainage of the collected pericardial effusion along with thyroxine replacement to which they responded. The presence of cardiac tamponade with bradycardia should raise a suspicion of a hypothyroid etiology. Early diagnosis and treatment of hypothyroidism are essential to prevent such complications.
HOW TO CITE THIS ARTICLE
Panda PK, Pattar S, Singh BO, Cheema T. Primary Hypothyroidism Presenting as Cardiac Tamponade. Indian J Crit Care Med 2022;26(5):655-657.
PubMed: 35719435
DOI: 10.5005/jp-journals-10071-24210 -
Hippokratia 2022
PubMed: 37188046
DOI: No ID Found -
JACC. Case Reports Dec 2019A 52-year-old female developed acute idiopathic pericarditis, which was complicated with tamponade. Constrictive physiology persisted after pericardiocentesis, and...
A 52-year-old female developed acute idiopathic pericarditis, which was complicated with tamponade. Constrictive physiology persisted after pericardiocentesis, and effusive-constrictive pericarditis (ECP) was diagnosed. Constrictive physiology improved in 10 days with anti-inflammatory therapy. This case was remarkable because it showed that ECP may present in an acute and reversible form. ().
PubMed: 34316891
DOI: 10.1016/j.jaccas.2019.08.027 -
JACC. Case Reports Jun 2023Left atrial appendage collapse is a relatively unusual echocardiographic finding. Although in post-cardiac surgery patients it may be an early sign of cardiac tamponade,...
Left atrial appendage collapse is a relatively unusual echocardiographic finding. Although in post-cardiac surgery patients it may be an early sign of cardiac tamponade, and pericardiocentesis should be discussed, a conservative approach may be followed in cases secondary to viral infection without confusing it with a left atrial appendage thrombus. ().
PubMed: 37283826
DOI: 10.1016/j.jaccas.2023.101872 -
Seminars in Interventional Radiology Jun 2022Pericardial effusions can occur from multiple different etiologies. Although often incidentally noted or clinically silent, pericardial effusions may cause significant... (Review)
Review
Pericardial effusions can occur from multiple different etiologies. Although often incidentally noted or clinically silent, pericardial effusions may cause significant hemodynamic compromise. In some of these patients, pericardiocentesis may be temporizing only and either repeat procedures or placement of pericardial drains may be preferable. While cardiologists typically perform pericardial drain placement, it is a procedure that may also be performed by interventional radiologists. This article describes for the interventional radiologist the indications and placement technique, as well as potential complications occurring from pericardial drain placement.
PubMed: 36062234
DOI: 10.1055/s-0042-1753523 -
ESMO Open Feb 2022Lung cancer with related pericardial effusion is not rare. Intervention is a crucial step for symptomatic effusion. It is unknown, however, whether the different...
BACKGROUND
Lung cancer with related pericardial effusion is not rare. Intervention is a crucial step for symptomatic effusion. It is unknown, however, whether the different invasive interventions for pericardial effusion result in different survival outcomes. This study analyzed the clinical characteristics and prognostic factors for patients with non-small-cell lung cancer (NSCLC) who have undergone different procedures.
METHODS
From January 2006 to June 2018, we collected data from patients with NSCLC who have received invasive intervention for pericardial effusions. The patients were divided into three categories: simple pericardiocentesis, balloon pericardiotomy, and surgical pericardiectomy. Kaplan-Meier curve and log-rank test were used to analyze the pericardial effusion recurrence-free survival (RFS) and overall survival (OS).
RESULTS
A total of 244 patients were enrolled. Adenocarcinoma (83.6%) was the major NSCLC subtype. Invasive intervention, including simple pericardiocentesis, balloon pericardiotomy, and surgical pericardiectomy, had been carried out on 52, 170, and 22 patients, respectively. The 1-year RFS rates in simple pericardiocentesis, balloon pericardiotomy, and surgical pericardiectomy were 19.2%, 31.2%, and 31.8%, respectively (P = 0.128), and the median RFS was 1.67, 5.03, and 8.32 months, respectively (P = 0.008). There was no significant difference in OS, however, with the median OS at 1.67, 6.43, and 8.32 months, respectively (P = 0.064). According to the multivariable analysis, the gravity in pericardial fluid analysis, receiving systemic therapy after pericardial effusion, and the time period from stage IV lung cancer to the presence of pericardial effusion were independent prognostic factors for pericardial effusion RFS and OS.
CONCLUSIONS
Patients who have undergone simple pericardiocentesis alone for the management of NSCLC-related pericardial effusion have lower 1-year RFS rates than those who have undergone balloon pericardiotomy and surgical pericardiectomy. Therefore, balloon pericardiotomy and surgical pericardiectomy should be carried out for patients with NSCLC-related pericardial effusion if tolerable.
Topics: Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Pericardial Effusion; Pericardiectomy; Pericardiocentesis
PubMed: 34953402
DOI: 10.1016/j.esmoop.2021.100354 -
JACC. Cardiovascular Interventions Jul 2022Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with increased risk of periprocedural complications. Estimating the risk of...
BACKGROUND
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with increased risk of periprocedural complications. Estimating the risk of complications facilitates risk-benefit assessment and procedural planning.
OBJECTIVES
This study sought to develop risk scores for in-hospital major adverse cardiovascular events (MACE), mortality, pericardiocentesis, and acute myocardial infarction (MI) in patients undergoing CTO PCI.
METHODS
The study analyzed the PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; NCT02061436) and created risk scores for MACE, mortality, pericardiocentesis, and acute MI. Logistic regression prediction modeling was used to identify independently associated variables, and models were internally validated with bootstrapping.
RESULTS
The incidence of periprocedural complications among 10,480 CTO PCIs was as follows: MACE 215 (2.05%), mortality 47 (0.45%), pericardiocentesis 83 (1.08%), and acute MI 66 (0.63%). The final model for MACE included ≥65 years of age (1 point), moderate-severe calcification (1 point), blunt stump (1 point), antegrade dissection and re-entry (ADR) (1 point), female (2 points), and retrograde (2 points); the final model for mortality included ≥65 years of age (1 point), left ventricular ejection fraction ≤45% (1 point), moderate-severe calcification (1 point), ADR (1 point), and retrograde (1 point); the final model for pericardiocentesis included ≥65 years of age (1 point), female (1 point), moderate-severe calcification (1 point), ADR (1 point), and retrograde (2 points); the final model for acute MI included prior coronary artery bypass graft surgery (1 point), atrial fibrillation (1 point), and blunt stump (1 point). The C-statistics of the models were 0.74, 0.80, 0.78, 0.72 for MACE, mortality, pericardiocentesis, and acute MI, respectively.
CONCLUSIONS
The PROGRESS-CTO complication risk scores can facilitate estimation of the periprocedural complication risk in patients undergoing CTO PCI.
Topics: Chronic Disease; Coronary Angiography; Coronary Occlusion; Female; Humans; Myocardial Infarction; Percutaneous Coronary Intervention; Prospective Studies; Registries; Risk Factors; Stroke Volume; Time Factors; Treatment Outcome; Ventricular Function, Left
PubMed: 35863789
DOI: 10.1016/j.jcin.2022.06.007