Review

Authors: Juan Guido Chiabrando, Aldo Bonaventura, Alessandra Vecchié...

Pericarditis refers to the inflammation of the pericardial layers, resulting from a variety of stimuli triggering a stereotyped immune response, and characterized by chest pain associated often with peculiar electrocardiographic changes and, at times, accompanied by pericardial effusion. Acute pericarditis is generally self-limited and not life-threatening; yet, it may cause significant short-term disability, be complicated by either a large pericardial effusion or tamponade, and carry a significant risk of recurrence. The mainstay of treatment of pericarditis is represented by anti-inflammatory drugs. Anti-inflammatory treatments vary, however, in both effectiveness and side-effect profile. The objective of this review is to summarize the up-to-date management of acute and recurrent pericarditis.

Topics: Acute Disease; Anti-Inflammatory Agents; Cardiac Tamponade; Disease Management; Echocardiography; Electrocardiography; Humans; Pericarditis; Recurrence; Review Literature as Topic; Tomography, X-Ray Computed

PubMed: 31918837
DOI: 10.1016/j.jacc.2019.11.021

Review

Authors: Olfa Hamzaoui, Xavier Monnet, Jean-Louis Teboul...

Systolic blood pressure normally falls during quiet inspiration in normal individuals. Pulsus paradoxus is defined as a fall of systolic blood pressure of >10 mmHg during the inspiratory phase. Pulsus paradoxus can be observed in cardiac tamponade and in conditions where intrathoracic pressure swings are exaggerated or the right ventricle is distended, such as severe acute asthma or exacerbations of chronic obstructive pulmonary disease. Both the inspiratory decrease in left ventricular stroke volume and the passive transmission to the arterial tree of the inspiratory decrease in intrathoracic pressure contribute to the occurrence of pulsus paradoxus. During cardiac tamponade and acute asthma, biventricular interdependence (series and parallel) plays an important role in the inspiratory decrease in left ventricular stroke volume. Early recognition of pulsus paradoxus in the emergency room can help to diagnose rapidly cardiac tamponade. Measurement of pulsus paradoxus is also useful to assess the severity of acute asthma as well as its response to therapy. Recent development of noninvasive devices capable of automatic calculation and display of arterial pressure variation or derived indices should help improve the assessment of pulsus paradoxus at the bedside.

Topics: Asthma; Blood Pressure; Cardiac Tamponade; Heart; Heart Ventricles; Humans; Lung; Respiration; Respiration Disorders; Sphygmomanometers; Stroke Volume; Systole; Vascular Resistance

PubMed: 23222878
DOI: 10.1183/09031936.00138912

Authors: Savvy Nandal, Brian A Herman

Iatrogenic ventricular perforation of the myocardial wall is a rare but life-threatening complication. It has been described using pulmonary artery catheter, pigtail catheter, and Judkins catheter. Straight wires and catheters can be used to cross the aortic valve for left ventriculogram; however, the risk of perforation is higher compared with J-tip wires. Prompt recognition of cardiac tamponade and pericardial drain insertion is vital, but surgical patch repair may be required for definitive treatment. This case highlights the importance of increased vigilance and prompt management of cardiac tamponade with the use of high-risk equipment during cardiac catheterization.

Topics: Humans; Cardiac Tamponade; Cardiac Catheterization; Heart Ventricles; Pericardium; Heart Injuries; Catheters; Catheterization, Central Venous

PubMed: 36588097
DOI: 10.25270/jic/22.00136

Review

Authors: Neal T Patel, Miti S Shah, Amod Amritphale...

Upon initial discovery in late 2019, severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, has managed to spread across the planet. A plethora of symptoms affecting multiple organ systems have been described, with the most common being nonspecific upper respiratory symptoms: cough, dyspnea, and wheezing. However, the cardiovascular system is also at risk following COVID-19 infection. Numerous cardiovascular complications have been reported by physicians globally, in particular cardiac tamponade Physicians must hold a high index of suspicion in identifying and treating patients with cardiac tamponade who may have contracted the novel coronavirus. This review will describe the current epidemiology and pathophysiology of SARS-CoV-2 and cardiac tamponade, highlighting their clinical course progression and the implications it may have for the severity of both illnesses. The paper will also review published case reports of cardiac tamponade, clinical presentation, and treatment of this complication, as well as the disease as a whole.

Topics: Humans; COVID-19; SARS-CoV-2; Cardiac Tamponade

PubMed: 36155201
DOI: 10.1016/j.cpcardiol.2022.101417

Review

Authors: A Ancion, S Robinet, P Lancellotti...

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

Authors: Syed Wamique Yusuf, Smita I Negi, Jose Banchs...

Topics: Cardiac Tamponade; Echocardiography, Doppler, Color; Electrocardiography; Female; Heart Conduction System; Humans; Male; Neoplasms; Pericardial Effusion

PubMed: 26216008
DOI: 10.1002/clc.22415

Authors: Robert Hitchcock, Clark J Obr, Sudhakar Subramani...

INTRODUCTION

This simulation on cardiac tamponade and complete heart block in the context of severe aortic stenosis presents the learner with a rare (cardiac tamponade) and a common (complete heart block) complication in the intraoperative setting of transfemoral aortic valve implantation in a high-fidelity, low-risk simulation environment. Based on an amalgam of index cases, the simulation was developed to address a recognized area of need for cardiothoracic anesthesia scenarios in the simulation curriculum of our home institution.

METHODS

The simulation case file covered the case narrative, learning objectives, a summary of critical actions performed, and supplemental figures needed to complete the educational activity. A high-fidelity patient simulator, an anesthesia machine, monitors, and a computer capable of displaying standard computer slide presentation software and movie files provided the optimal environment for simulation.

RESULTS

Fifteen anesthesia residents experienced the simulation over the 2016-2017 and 2017-2018 academic years. The trainees who experienced this simulation improved their understanding of tamponade hemodynamic pathophysiology and recognition of hemodynamically unstable bradycardia.

DISCUSSION

This case has been an effective addition to the repertoire of simulation scenarios at the University of Iowa and has been incorporated into the general curriculum of simulation cases for mid-training junior and senior anesthesia residents.

Topics: Anesthesiology; Cardiac Tamponade; Electrocardiography; Heart Block; Humans; Internship and Residency; Iowa; Risk Factors; Simulation Training; Transcatheter Aortic Valve Replacement

PubMed: 30800979
DOI: 10.15766/mep_2374-8265.10779

Authors: Andreas Metzner, Arian Sultan, Piotr Futyma...

AIMS

Pericardial tamponade (PT) is the most frequent severe complication during electrophysiology (EP) procedures and requires immediate, co-ordinated, and effective treatment. However, multiple aspects of PT treatment are either not standardized or are under ongoing debate.

METHODS AND RESULTS

An online questionnaire consisting of 26 multiple-choice questions was sent out to the European Heart Rhythm (EHRA) Research Network and also distributed via social media outputs. The EHRA survey was conducted between May and June 2023. A total of 213 replies were received from European (87%) and non-European countries. Ninety per cent of all participants perform interventions in dedicated EP labs equipped with different ablation platforms. In case of PT, most participants use X-ray as the main imaging modality guiding pericardial puncture, predominantly aiming for an anterior puncture site. Sheaths of different sizes are introduced into the pericardial space (84.3%), followed by a pigtail catheter. Application of protamine is an established but variable step in the majority (84.6%). Novel oral anticoagulants (NOAC) antidotes are not used by 73.3% of participants, while 15.2% routinely apply them. Re-transfusion of aspirated blood is performed by 72.1% [before protamine administration (18.2%), after protamine administration (13.5%), if pericardial effusion cannot be controlled (40.4%)]. A total of 72.4% re-transfuse without blood filter systems. A decision for surgical intervention is mostly taken if bleeding continues despite all interventional measures.

CONCLUSION

The current survey demonstrates that the management of PT is heterogeneous among centres. The findings of this survey may help to guide operators in their treatment and decisions in the setting of PT.

Topics: Humans; Anticoagulants; Cardiac Tamponade; Surveys and Questionnaires; Protamines; Electrophysiology

PubMed: 38163951
DOI: 10.1093/europace/euad378

Authors: Waqas Ullah, Asrar Ahmad, Maryam Mukhtar...

BACKGROUND

The objective of this study is to review acupuncture-related cardiac complications, such as infective endocarditis (IE), cardiac tamponade (CT), pericarditis, and cardiac rupture, as there is no known reported literature to determine the burden of cardiac adverse events due to acupuncture.

METHODS

Structured computerized databases were searched using the special Medical Subject Heading (MeSH). Manual search using the references of relevant articles was also performed.

RESULTS

A total of 133 articles were initially retrieved, but careful reading resulted in only 30 cases of relevant cardiac adverse events. There were 8 articles of infective complications (mostly IE), while 22 articles of CT have been reported to date. The diagnoses were made with echocardiography and patients were treated with intravenous antibiotics. The source of the infection was mostly localized to acupuncture needle prick sites, such as earlobes and legs. Mortality rate for post-acupuncture CT was not significantly higher than infective cardiac complication (Pearson's Chi-square = 0.559; likelihood ratio = 0.553). However, the weighted percentage of death was about 80% in CT vs only 20% mortality for infective cardiac complications. On the other hand, CT was the most common presentation when the needle pricks were close to the heart, and had a clinical presentation of hypotension and venous distention.

CONCLUSIONS

Although the universally reported complications of acupuncture are low, and the procedure itself has been deemed low risk in acupuncture-related literature, these cardiac complications are alarming. To avoid these potentially catastrophic consequences, more education needs to be done for adopting safer techniques.

Topics: Acupuncture Therapy; Cardiac Tamponade; Endocarditis; Heart Rupture; Humans; Pericarditis; Risk Adjustment; Risk Factors

PubMed: 30927540
DOI: 10.25270/jic/18.00295

Authors: Seng Chan You, Chi Young Shim, Geu-Ru Hong...

This study aimed to investigate the incidence, predictors, and clinical outcomes of cardiac tamponade after heart valve surgery. A total of 556 patients who underwent heart valve surgery in a single tertiary center between January 2010 and March 2012 were studied. All patients underwent transthoracic echocardiography (TTE) about 5 days after surgery and TTE was repeated regularly. Patients with suspected acute pericardial hemorrhage were excluded. Cardiac tamponade occurred in twenty-four (4.3%) patients and all underwent surgical or percutaneous pericardial drainage. The median time of pericardial drainage after surgery was 17 (interquartile range, IQR, 13-30) days. Infective endocarditis, mechanical valve replacement of aortic or mitral valve, and any amount of pericardial effusion (PE) on the first postoperative TTE were related to the occurrence of cardiac tamponade (all p<0.05). After multivariate adjustment, occurrence of cardiac tamponade was associated with any amount of PE on the first postoperative TTE (hazard ratio, HR, 14.00, p<0.001) and mechanical valve replacement (HR 2.69, p = 0.025). The mean hospital days in patients with cardiac tamponade was higher than those without (34.9 vs. 13.5, p = 0.031). After pericardial drainage, there was no echocardiographic recurrence of significant PE during a median of 34.8 (IQR 14.9-43.7) months after surgery. Cardiac tamponade after heart valve surgery is not uncommon. Patients with any amount of PE at the first postoperative TTE or mechanical valve replacement should receive higher attention with regard to the occurrence of cardiac tamponade. Although it prolongs hospital stay, cardiac tamponade exhibits a benign clinical course without recurrence after timely intervention.

Topics: Adult; Aged; Biomarkers; Cardiac Surgical Procedures; Cardiac Tamponade; Echocardiography; Female; Heart Valve Diseases; Humans; Incidence; Kaplan-Meier Estimate; Male; Middle Aged; Mortality; Patient Outcome Assessment; Postoperative Complications; Prognosis; Risk Factors

PubMed: 27855225
DOI: 10.1371/journal.pone.0165754