An echocardiogram showed a 3cm global pericardial effusion with signs of cardiac tamponade figure 1b. Hemopericardium, cardiac tamponade and liver abscess 326 neumol cir tora, ol. Aug 24, 2011 this is the primary test used to diagnose and manage cardiac tamponade. In this case report we present and discuss pericarditis leading to cardiac tamponade as the initial manifestation of csle. The european association for cardiothoracic surgery eacts. Cardiac tamponade is a medical emergency that develops when a pericardial effusion reaches a critical amount, limiting cardiac inflow and leading to hemodynamic compromise. Diagnosis and therapeutic management of patients with cardiac.
Cardiac tamponade is a serious medical condition in which blood or fluids fill the space between the sac that encases the heart and the heart muscle. Unexpected resistance to external cardiac compression may. The task force for the diagnosis and management of pericardial diseases of the european society of cardiology escendorsed by. Massive pericardial effusion and cardiac tamponade as the presentation form of. Transthoracic echocardiography tte revealed a large global pericardial effusion measuring 40mm in diameter with swinging of the heart freely in an anteriorposterior fashion fig. Nov 28, 2018 cardiac tamponade is a clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise. Symptom signs and laboratory tests in cardiac tamponade are shown in tables 16. I describe a case of cardiac tamponade whose initial diagnosis was pulmonary embolism in a 72yearold female brought to our hospital with shortness of breath over the last three weeks. Lany 2008, alguns autors estatunidencs lestimaven en 2 casos10.
Taponamiento cardiaco por derrame pericardico masivo secundario a hipotiroidismo primario. The normal pericardium can stretch to accommodate physiologic changes in cardiac volume. Cardiac tamponade, also known as pericardial tamponade, is when fluid in the pericardium the sac around the heart builds up, resulting in compression of the heart. In the cardiac catheterization laboratory, tamponade can result as a complication of any invasive procedure and lead to the rapid demise of the patient due to the swift accumulation of fluid in a poorly compliant pericardial. The condition is a medical emergency, the complications of which include pulmonary edema, shock, and death. However, after its reserve volume is exceeded, the pericardium markedly stiffens. Cardiac tamponade cardiac tamponade, which may be acute or subacute, is characterized by the accumulation of pericardial fluid under pressure. Cardiac tamponade is the result of an accumulation of fluid, pus, blood, gas, or benign or malignant neoplastic tissue within the pericardial cavity, which can occur either rapidly or gradually over time, but eventually, results in impaired cardi. Georges hospital, london, uk correspondence to pete. Open surgical drainage with or without pericardiectomy pericardial window.
Cardiac tamponade is pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle and the outer covering sac of the heart. Cateterizacioncardiacaa tubelike instrument inserted into the heart through a vein or artery usually in the arm or leg to detect problems with the heart and its blood supply 14. Cardiac tamponade will usually present with hypotension, muffling of heart sounds, and accentuated neck veins. This prevents the heart ventricles from expanding fully.
In our case, we opted for open surgical removal due to association with perforation and cardiac tamponade. It should relieve pressure on your heart and then treat the underlying. Pericardial diseases of any aetiology may cause cardiac tamponade, but with. Due to the patients clinical instability, drainage of the pericardial effusion was mandatory, but pericardiocentesis was unsuccessful due to catheter obstruction, and so surgical drainage was performed through a pleuropericardial window. If this occurs quickly, pressure rises in this space b ecause the pericardium cannot stretch. Clinicians should understand the tamponade physiology, especially because it can develop without large pericardial effusion.
The treatment of cardiac tamponade has two purposes. Cardiac tamponade is an emergency situation requiring fast diagnosis and drainage of the pericardial effusion pericardiocentesis or pericardial window. However, cardiac tamponade is associated with a variety of abnormalities that lead to changes on the electrocardiogram ecg, chest xray, and on. Because cardiac tamponade is a medical emergency, immediate attempts to evacuate the blood from the pericardium is of utmost priority to avoid. European heart journal, volume 35, issue 34, 7 september 2014, pages 2279. Cronicon open access ec emergency medicine and critical care.
The incidence is 2 cases per 10,000 population in the united states of america. The visceral pericardium is a serosal monolayer that adheres firmly to the epicardium, reflects over the origin of the great vessels, and together with a tough, fibrous parietal layer, envelops the heart. Cardiac tamponade an overview sciencedirect topics. Cardiac tamponade is a clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise. Chest computerized tomography ct of a patient who was admitted with a picture consistent with cardiac tamponade. Article pdf available january 2014 with 1,405 reads. Cardiac tamponade as cause of respiratory distress and. Since cardiac tamponade can develop slowly, and the symptoms and signs are neither highly sensitive nor specific, halpern et al. Diagnostico y guia terapeutica del paciente con taponamiento. Article pdf available in bmj case reports 2014dec22 1. Mar 17, 2015 cardiac tamponade is a medical emergency that develops when a pericardial effusion reaches a critical amount, limiting cardiac inflow and leading to hemodynamic compromise. Cardiac tamponade is clinically defined as the accumulation of fluid such as blood in the pericardial sac which alters cardiac filling. The condition is a medical emergency, the complications of which include pulmonary edema, shock, and. Cardiac tamponade resembling an acute myocardial infarction as the initial manifestation of metastatic pericardial adenocarcinoma.
Variants include low pressure occult and regional cardiac tamponade. Cardiac tamponade results from an accumulation of pericardial fluid under pressure, leading. Cardiac tamponade related to trauma or hiv is more common in young adults. Pulsus paradoxus and pericardiocentesis are discussed.
Tamponade due to malignancy andor chronic kidney injury occurs more frequently in elderly individuals. Echocardiography provides valuable insights into identifying patients who are suitable candidates and further facilitates pericardiocentesis by improving guidance. Cardiac tamponade is a kind of cardiogenic shock and medical emergency. In this condition, blood or fluid collects in the sac surrounding the heart.
On the ct scan performed after pericardiocentesis the presence of an alreadyidentified pericardial effusion arrow was revealed, but allowed identification of the presence of lung tumors, adenopathy, and an image suggestive of carcinomatous lymphangitis. Derrame pericardico y taponamiento cardiaco sciencedirect. Med j malaysia vol 69 no 1 february 2014 39 although diagnosis of cardiac tamponade is often clinical with equivocal findings evaluated with echocardiography as the technique of choice, it is often not feasible due to patient habitus or often not performed due to low clinical suspicion from masked symptomssigns. Cardiac tamponade is a lifethreatening disorder that can result from any condition that causes a pericardial effusion. In both cardiac tamponade and constrictive pericarditis, cardiac filling is impeded by an external force. Cardiac tamponade is caused by the accumulation of blood, fluid, pus, clots, or gas in the pericardial space, resulting in reduced ventricular filling. Massive pericardial effusion with cardiac tamponade. Taponamiento cardiaco enfermedades cardiovasculares. Pericardial tamponade, an uncommon but often fatal patient event in the neonatal intensive care unit nicu, can be caused by pericardial extravasation of. Although cardiac tamponade is a clinical diagnosis, echocardiography figure 2 provides useful information and is the cornerstone during evaluation availability, bedside, and treatment. This occurs with a large pericardial effusion constricts the heart and can lead to shock.
Cardiac tamponade is a sudden life threatening condition characterized by the accumulation of pericardial fluid under pressure which decreases the movement of parietal pericardium and compresses all the chambers such that systemic venous return to the ra is compromised 35. The pericardium is composed of visceral and parietal components. An important pathophysiologic feature of both cardiac tamponade and. Cardiac tamponade is caused by the accumulation of fluid in the pericardial space. Current pericardial evacuation techniques and approaches are varied. Tamponamiento cardiaco, pericardiocentesis youtube. In this case report we present and discuss pericarditis leading to cardiac. Intracardiac embolization of inferior vena cava filter. Symptoms typically include those of cardiogenic shock including shortness of breath, weakness, lightheadedness, and cough. If the pressure is higher than in the various chambers of your heart, they get compressed and some of. Meigslike syndrome presenting as cardiac tamponade revista. Pdf cardiac tamponade, a clinical challenge researchgate. This is the primary test used to diagnose and manage cardiac tamponade. Diagnosis and therapeutic management of patients with.
A severe and unusual complication in central lines i. Cardiac tamponade is a medical emergency that requires hospitalization. Heightened ventricular interdependence coupled with progressive systolic predominance of an inspiratory increase in systemic venous return are largely responsible for the diagnostic physical and imaging signs. Patients suspected of having cardiac tamponade should be evaluated. Meigslike syndrome presenting as cardiac tamponade. Dec 12, 2002 pericardial tamponade, an uncommon but often fatal patient event in the neonatal intensive care unit nicu, can be caused by pericardial extravasation of infusate delivered through peripherally.
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