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Indian Journal of Pediatrics Mar 2021
Topics: Humans; Infant; Pericardial Effusion
PubMed: 33078284
DOI: 10.1007/s12098-020-03533-3 -
La Radiologia Medica Apr 2021The clinical spectrum of pericardial effusions varies from innocuous serous fluid to life-threatening hemopericardium. A misdiagnosis may be made by similar clinical... (Review)
Review
The clinical spectrum of pericardial effusions varies from innocuous serous fluid to life-threatening hemopericardium. A misdiagnosis may be made by similar clinical presentation of acute chest pain/hypotension. Echocardiography is the first-line test for diagnosis of pericardial effusion and its etiology, but sometimes there are different drawbacks to the correct cardiovascular ultrasound diagnosis. Radiologists are reporting an increasing amount of thoracic Multidetector CT examinations at the emergency department. Multidetector CT has now become an established and complementary method for cardiac imaging, and diseases of the pericardium can now be quickly identified with increasing certainty. The aim of this review is to discuss the hemopericardium key Multidetector CT features in acute clinical setting which indicate the need to proceed with predominantly medical or surgical treatment, however, being able to identify forms of bleeding pericardial effusion for which only "a watch and wait strategy" and/or deferred treatment is indicated. In the emergency care setting, radiologists must be aware of different findings of hemopericardium in order to address a tailored and timely management approach.
Topics: Cardiovascular Diseases; Diagnosis, Differential; Humans; Multidetector Computed Tomography; Pericardial Effusion; Pericardial Fluid; Pericardium; Rupture, Spontaneous; Thoracic Injuries
PubMed: 33136215
DOI: 10.1007/s11547-020-01303-x -
Nihon Rinsho. Japanese Journal of... Sep 2007
Review
Topics: Aortic Dissection; Anticoagulants; Aortic Aneurysm; Cardiac Surgical Procedures; Cardiac Tamponade; Diagnosis, Differential; Heart Neoplasms; Heart Rupture, Post-Infarction; Humans; Pericardial Effusion; Pericardium; Thoracic Injuries
PubMed: 17953030
DOI: No ID Found -
Jornal Brasileiro de Pneumologia :... Jan 2021
Topics: Echocardiography; Humans; Pericardial Effusion
PubMed: 33503136
DOI: 10.36416/1806-3756/e20200587 -
The American Journal of Emergency... Aug 2022Pericardial tamponade requires timely diagnosis and management. It carries a high mortality rate. (Review)
Review
INTRODUCTION
Pericardial tamponade requires timely diagnosis and management. It carries a high mortality rate.
OBJECTIVE
This review incorporates available evidence to clarify misconceptions regarding the clinical presentation, while providing an in-depth expert guide on bedside echocardiography. It also details the decision-making strategy for emergency management including pericardiocentesis, along with pre- and peri-procedural pearls and pitfalls.
DISCUSSION
Pericardial effusions causing tamponade arise from diverse etiologies across acute and sub-acute time courses. The most frequently reported symptom is dyspnea. The classically taught Beck's triad (which includes hypotension) does not appear commonly. Echocardiographic findings include: a pericardial effusion (larger size associated with tamponade), diastolic right ventricular collapse (specific), systolic right atrial collapse (sensitive), a plethoric non-collapsible inferior vena cava (sensitive), and sonographic pulsus paradoxus. Emergent pericardiocentesis is warranted by hemodynamic instability, impending deterioration, or cardiac arrest. Emergent surgical indications include type A aortic dissection causing hemopericardium, ventricular free wall rupture after acute myocardial infarction, severe chest trauma, and iatrogenic hemopericardium when bleeding cannot be controlled percutaneously. Pre-procedure management includes blood products for patients with traumatic hemopericardium; gentle intravenous fluids to hypotensive, hypovolemic patients with consideration for vasoactive medications; treatment of anticoagulation, coagulopathies, and anemia. Positive-pressure ventilation and intravenous sedation can lower cardiac output and should be avoided if possible. Optimal location for echocardiography-guided pericardiocentesis is the largest, shallowest fluid pocket with no intervening vital structures. Patient positioning to prevent hypoxia and liberal amounts of local anesthesia can facilitate patients remaining still. Safe needle guidance and confirmation of catheter placement is achieved using low-depth sonographic views, injection of agitated saline, and evaluation of initial aspirate for hemorrhage. Pericardial fluid should be drained slowly to avoid pericardial decompression syndrome.
CONCLUSION
An understanding of the pathophysiology, clinical presentation, echocardiographic findings, and time-sensitive management of pericardial tamponade is essential for emergency physicians.
Topics: Cardiac Tamponade; Echocardiography; Emergency Medicine; Humans; Hypotension; Pericardial Effusion; Pericardiocentesis
PubMed: 35696801
DOI: 10.1016/j.ajem.2022.05.001 -
Revue Medicale de Liege May 2018Cardiac tamponade is a vital emergency. It occurs when the accumulation of intra-pericardial fluid exceeds the pericardial adaptation capacity. Pericardial pressure is... (Review)
Review
Cardiac tamponade is a vital emergency. It occurs when the accumulation of intra-pericardial fluid exceeds the pericardial adaptation capacity. Pericardial pressure is equalized with that of cardiac cavities and severe heart failure occurs, most often rapidly. Several clinical presentations are possible. The diagnosis is based on the assessment of pericardial effusion and its impact on the heart by echocardiography. Supportive treatments have limited effectiveness. The only emergency treatment is drainage of the pericardium by direct puncture or by surgical approach.
Topics: Cardiac Tamponade; Drainage; Echocardiography; Humans; Pericardial Effusion
PubMed: 29926566
DOI: No ID Found -
Progress in Cardiovascular Diseases 2017The presentation of a patient with a pericardial effusion can range from an incidental finding to a life-threatening emergency. Accordingly, the causes of pericardial... (Review)
Review
The presentation of a patient with a pericardial effusion can range from an incidental finding to a life-threatening emergency. Accordingly, the causes of pericardial effusions are numerous and can generally be divided into inflammatory and non-inflammatory etiologies. For all patients with a suspected pericardial effusion, echocardiography is essential to define the location and size of an effusion. In pericardial tamponade, the hemodynamics relate to decreased pericardial compliance, ventricular interdependence, and an inspiratory decrease in the pressure gradient for left ventricular filling. Echocardiography provides insight into the pathophysiologic alterations, primarily through an assessment of chamber collapse, inferior vena cava plethora, and marked respiratory variation in mitral and tricuspid inflow. Once diagnosed, pericardiocentesis is performed in patients with tamponade, preferably with echocardiographic guidance. With a large effusion but no tamponade, pericardiocentesis is rarely needed for diagnostic purposes, though is performed if there is concern for a bacterial infection. In patients with malignancy, pericardial window is preferred given the risk for recurrence. Finally, large effusions can progress to tamponade, but can generally be followed closely until the extent of the effusion facilitates safe pericardiocentesis.
Topics: Cardiac Tamponade; Disease Management; Echocardiography; Hemodynamics; Humans; Pericardial Effusion; Pericardiocentesis
PubMed: 28062268
DOI: 10.1016/j.pcad.2016.12.009 -
Journal of Medical Ultrasonics (2001) Jan 2019To our knowledge, only 15 cases of delayed traumatic hemopericardium resulting from non-penetrating chest trauma have been reported. We present the case of a 63-year-old... (Review)
Review
To our knowledge, only 15 cases of delayed traumatic hemopericardium resulting from non-penetrating chest trauma have been reported. We present the case of a 63-year-old man with delayed hemopericardium, 2 months after striking the anterior chest on a mailbox when he fell down three steps during a postal delivery. Our case and review of the previously reported cases suggest that some cases might show quite slow progression of blood accumulation. Therefore, careful observation of patients who have experienced blunt trauma of the anterior chest is necessary.
Topics: Accidental Falls; Humans; Male; Middle Aged; Pericardial Effusion; Thoracic Injuries; Time Factors; Wounds, Nonpenetrating
PubMed: 30094767
DOI: 10.1007/s10396-018-0895-9 -
Journal of Cardiothoracic and Vascular... Aug 2018
Topics: Aged, 80 and over; Female; Humans; Hypotension; Pericardial Effusion; Postoperative Complications; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 29706568
DOI: 10.1053/j.jvca.2018.03.003 -
Ryoikibetsu Shokogun Shirizu 1996
Review
Topics: Diagnosis, Differential; Heart Injuries; Heart Rupture, Post-Infarction; Humans; Pericardial Effusion
PubMed: 9117712
DOI: No ID Found