Background: Pericardial effusion may progress to cardiac tamponade when pressure around the heart increases to a level comparable to that of the right and left atria. Patients with cardiac tamponade need timely comple...Background: Pericardial effusion may progress to cardiac tamponade when pressure around the heart increases to a level comparable to that of the right and left atria. Patients with cardiac tamponade need timely completion of emergency pericardiocentesis to relieve the threat to the patient’s life, and to save valuable time for patients who need emergency thoracotomy and pericardial window drainage. Pericardiocentesis is a necessary clinical skill for residents in standardized training. In addition, nurses who are familiar with this technology can better assist clinicians to perform this operation. In order to make the medical staff quickly master the theoretical knowledge of emergency pericardiocentesis, we designed a “1 + 1 + 1” teaching method for the theoretical teaching of emergency pericardiocentesis. Objective: This study aims to explore the effectiveness of the “1 + 1 + 1” teaching method in the theoretical teaching of emergency pericardiocentesis. Methods: We used an English teaching video of emergency pericardiocentesis and applied the “1 + 1 + 1” teaching method for theoretical teaching. A questionnaire survey was conducted before and after the lecture among 19 medical staff of different years of service to understand their mastery of the theoretical content of emergency pericardiocentesis before and after the lecture. According to the years of service, the medical staff were divided into three groups: 1 - 3 years (Group A), 4 - 10 years (Group B), and over 10 years (Group C), and the changes in the mastery of various contents by the overall medical staff and each group were statistically analyzed. Results: Before the lecture, the number of people who mastered the indications, contraindications, most commonly used methods, and common complications of emergency pericardiocentesis were 15, 12, 16, and 17, respectively, whereas after the lecture, these numbers increased to 17, 19, 19, and 19, respectively. The overall mastery before and after the lecture was statistically significant (p Conclusion: The “1 + 1 + 1” teaching method can effectively improve the overall mastery level of medical staff’s theoretical knowledge of emergency pericardiocentesis, especially in improving the mastery of contraindications of this operation.展开更多
AIM:To evaluate the role and outcome of pericardiocentesis with intrapericardial cisplatin instillation for malignant pericardial effusion resulting from esophageal cancer. METHODS:We retrospectively studied 7 patient...AIM:To evaluate the role and outcome of pericardiocentesis with intrapericardial cisplatin instillation for malignant pericardial effusion resulting from esophageal cancer. METHODS:We retrospectively studied 7 patients who underwent pericardiocentesis with intrapericardial cisplatin instillation for malignant pericardial effusion resulting from esophageal cancer.After pericardiocentesis,we performed catheterization of the pericardial space under ultrasonogram guidance.Malignant etiology of the pericardial fluid was confirmed by cytological examination.Subsequently,cisplatin(10 mg in 20 mL normal saline) was instilled into the pericardial space. RESULTS:The mean total volume of the aspirated effusion fluid was 782±264 mL(range,400-1200 mL) . The drainage catheter was successfully removed in all patients,and the mean duration of pericardial drainagewas 7.7±2.7 d(range,5-13 d) .No fluid reaccumulation was observed.Mean survival time was 120±71 d(range,68-268 d) . CONCLUSION:Pericardiocentesis along with catheter drainage appears to be a safe and effective for pericardial malignant effusion and tamponade,and cisplatin instillation prevents recurrence.展开更多
BACKGROUND:Traditionally performed using a subxiphoid approach,the increasing use of point-of-care ultrasound in the emergency department has made other approaches(parasternal and apical)for pericardiocentesis viable....BACKGROUND:Traditionally performed using a subxiphoid approach,the increasing use of point-of-care ultrasound in the emergency department has made other approaches(parasternal and apical)for pericardiocentesis viable.The aim of this study is to identify the ideal approach for emergency-physician-performed ultrasound-guided pericardiocentesis as determined by ultrasound image quality,distance from surface to pericardial fl uid,and likely obstructions or complications.METHODS:A retrospective review of point-of-care cardiac ultrasound examinations was performed in two urban academic emergency departments for the presence of pericardial eff usions.The images were reviewed for technical quality,distance of eff usion from skin surface,and predicted complications.RESULTS:A total of 166 pericardial effusions were identified during the study period.The mean skin-to-pericardial fl uid distance was 5.6 cm(95%confi dence interval[95%CI]5.2-6.0 cm)for the subxiphoid views,which was signifi cantly greater than that for the parasternal(2.7 cm[95%CI 2.5-2.8 cm],P<0.001)and apical(2.5 cm[95%CI 2.3-2.7 cm],P<0.001)views.The subxiphoid view had the highest predicted complication rate at 79.7%(95%CI 71.5%-86.4%),which was signifi cantly greater than the apical(31.9%;95%CI 21.4%-44.0%,P<0.001)and parasternal(20.2%;95%CI 12.8%-29.5%,P<0.001)views.CONCLUSIONS:Our results suggest that complication rates with pericardiocentesis will be lower via the parasternal or apical approach compared to the subxiphoid approach.The distance from skin to fl uid collection is the least in both of these views.展开更多
Pericardiocentesis is a common therapeutic procedure for pericardial tamponade due to pericardial effusion as well as a diagnostic procedure to obtain fluid for cytopathologic examination.Standard methods include ultr...Pericardiocentesis is a common therapeutic procedure for pericardial tamponade due to pericardial effusion as well as a diagnostic procedure to obtain fluid for cytopathologic examination.Standard methods include ultrasound or fluoroscopic guidance,which generally result in high success rates(over 95%).[1,2].The complication rate of pericardiocentesis is low with reported incidences of l%-2%.[3]In the past,the most common indications for pericardiocentesis include uremia,tuberculous pericarditis or malignant pericardial effusions.However,with the increasing number of catheter-based interventional cardiac procedures,iatrogenic pericardial effusions are becoming more frequent[4-6].展开更多
A 72-year-old female was admitted to the CCU with a recent onset of progressive breathlessness for bedside pericardial drainage for chronic pericardial effusion. After an uncomplicated drainage procedure, initially a ...A 72-year-old female was admitted to the CCU with a recent onset of progressive breathlessness for bedside pericardial drainage for chronic pericardial effusion. After an uncomplicated drainage procedure, initially a serous straw coloured fluid was aspired with subsequent hemorrhagic aspiration with haemoglobin value similar to the peripheral blood. The patient showed initially transient improvement followed by rapid deterioration into severe shock and death. Signs of infero-posterior myocardial infarction (MI) were seen on the ECG. Before death, further interventions were refused by her and her family but a permission was given for autopsy. At autopsy, right ventricular rupture was seen with a 0.6 cm tear with a large amount of 800 cc bloody fluid with clots. The result of histopathologic study of the tear was resembling three-days old MI. The drain was found to be properly localized in the pericardial space, was not blocked and caused no harm to the myocardium. Furthermore, histopathologic examination revealed pulmonary adenocarcinoma of the left upper lobe, pleuritis and lymphangitis carcinomatosa and enlarged mediastinal lymph nodes. A case of fatal complication is reported following bedside pericardial drainage. Postmortal, right ventricular tear mimicked myocardial infarction.展开更多
BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits f...BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits for nonischemic chest pain in Western Europe and North America.The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes.Acute pericarditis is generally self-limited.However,some cases may be complicated by either tamponade or a large pericardial effusion,which carries a significant risk of recurrence.Risk factors for acute pericarditis include viral infections,cardiac surgery,and autoimmune disorders.A rarer cause of pericardial inflammation includes pneumonia,which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics.Purulent pericarditis carries a high fatality rate,especially in the setting of tamponade,and is invariably deadly without the administration of antibiotics.Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.CASE SUMMARY We present the case of a 62-year-old woman who sought medical attention at the emergency department(ED)due to a 5-day history of chest pain,shortness of breath,and subjective fevers.Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein.A chest X-ray revealed a new focal density within the left lower lung base,and a bedside point-of-care ultrasound showed a pericardial fluid collection.The patient was subsequently admitted,where she underwent pericardiocentesis.Fluid cultures from drainage grew streptococcus pneumoniae.She was started on broadspectrum antibiotics immediately after the procedure.The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.CONCLUSION This case report emphasizes a unique complication of community-acquired pneumonia.Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium.This condition is virtually fatal without the administration of antibiotics.Therefore,in the context of suspected pneumonia and a new pericardial fluid collection on imaging,clinicians should suspect purulent pericarditis until proven otherwise,which requires emergent intervention.展开更多
BACKGROUND Development of pericardial effusion in patients with left ventricular assist devices(LVADs)can be detrimental to health outcomes.This study aims to elucidate the prevalence and risk factors for pericardial ...BACKGROUND Development of pericardial effusion in patients with left ventricular assist devices(LVADs)can be detrimental to health outcomes.This study aims to elucidate the prevalence and risk factors for pericardial effusion in patients with LVADs.AIM To elucidate risk factors associated with the presence of pericardial effusion in patients with LVADs and compare the clinical outcomes of those with and without pericardial effusion.The secondary goal is to determine the incidence of pericardiocentesis and pericardial window placement in patients with LVADs experiencing pericardial effusion.METHODS Data were obtained from the National Inpatient Sample database between 2016 and 2018.Statistical analysis was performed using Pearsonχ2 test and multivariate logistic regression analysis to determine clinical outcomes of pericardial effusion and to identify variables associated with pericardial effusion in LVAD patients,respectively.RESULTS The prevalence of LVAD was 9850(0.01%)among total study patients(n=98112095).The incidence of pericardial effusion among LVAD patients was 640(6.5%).The prevalence of liver disease(26.6%vs 17.4%),chronic kidney disease(CKD;54.6%vs 49.4%),hypothyroidism(21.9%vs 18.1%),congestive heart failure(98.4%vs 96.5%),atrial fibrillation(Afib;58.59%vs 50.5%),coronary artery disease(CAD;11.7%vs 4.4%),dyslipidemia(31.3%vs 39.3%),and having undergone percutaneous coronary intervention(PCI;1.6%vs 0.7%)was higher in the pericardial effusion cohort vs the non-pericardial effusion cohort.Multivariate regression analysis demonstrated that CAD(OR=2.89)and PCI(OR=2.2)had the greatest association with pericardial effusion in patients with LVADs.These were followed by liver disease(OR=1.72),hypothyroidism(OR=1.2),electrolyte derangement(OR=1.2),Afib(OR=1.1),and CKD(OR=1.05).Among patients with LVADs,the median length of stay(33 days vs 27 days)and hospitalization cost(847525 USD vs 792616 USD)were significantly higher in the pericardial effusion cohort compared to the non-pericardial effusion cohort.There was no significant difference in mortality between cohorts.The prevalence of cardiac tamponade was 109(17.9%of LVAD patients with pericardial effusion).Ten(9.2%of LVAD patients with cardiac tamponade)patients underwent pericardiocentesis and 44(40.3%)received a pericardial window.CONCLUSION This study shows that liver disease,CKD,PCI,hypothyroidism,electrolyte derangement,Afib,and CAD had a significant association with pericardial effusion in LVAD patients.Hospitalization cost and length of stay were higher in the pericardial effusion group,but mortality was the same.展开更多
Pericardial decompression syndrome(PDS)is an infrequent,life-threatening complication following pericardial drainage for cardiac tamponade physiology.PDS usually develops after initial clinical improvement following p...Pericardial decompression syndrome(PDS)is an infrequent,life-threatening complication following pericardial drainage for cardiac tamponade physiology.PDS usually develops after initial clinical improvement following pericardiocentesis and is significantly underreported and may be overlooked in the clinical practice.Although the precise mechanisms resulting in PDS are not well understood,this seems to be highly associated with patients who have some underlying ventricular dysfunction.Physicians performing pericardial drainage should be mindful of the risk factors associated with the procedure including the rare potential for the development of PDS.展开更多
Background: Hypothyroidism is a commonly seen condition. The presence of pericardial effusion with cardiac tamponade as initial manifestation of this endocrinological condition is very unusual. Objectives: In hypothyr...Background: Hypothyroidism is a commonly seen condition. The presence of pericardial effusion with cardiac tamponade as initial manifestation of this endocrinological condition is very unusual. Objectives: In hypothyroidism pericardial fluid accu-mulates slowly, allowing adaptation and stretching of the pericardial sac, sometimes accommodating a large volume. Case Report: A 39 year-old female presented with chest pain, dyspnea and lower extremity edema for 1 day. Bradycardia, muffled heart sounds and severe hypertension were noticed. Chest radiograph showed an enlarged cardiac silhouette. A bedside echocardiogram revealed a cardiac tamponade, later she developed sudden hypotension and bradycardia that resolved after pericardiocentesis of 1 liter of pericardial fluid. The further laboratory evaluation revealed a TSH value of 69.3 miU/L and low T3 and free T4. The patient later developed reaccumulation of pericardial fluid with the need for creation of pericardial window. Conclusion: When the classic Beck’s triad is not present and bradycardia accompanies a cardiac tamponade, hypothyroidism should be strongly suspected. The requirement for thyroid hormone supplement is critical and is well reported. There is a chance of recurrence even after starting levothyroxine supplementation;and the associated hypertension usually requires treatment with more than one drug.展开更多
Introduction: Pericardial effusion is one of the common cardiac problems in our?part of the world and adds burden to the health and economy of the country, as it is associated with high risk of morbidity and mortality...Introduction: Pericardial effusion is one of the common cardiac problems in our?part of the world and adds burden to the health and economy of the country, as it is associated with high risk of morbidity and mortality. Our objective of the study was to determine the etiological spectrum of pericardial effusion, their clinical presentations and complications and assessing the usefulness of echocardiographic features of effusion in helping to determine the etiology. Methods: A cross-sectional observational prospective study of 63 patients with diagnosis of pericardial effusion was enrolled in the study. Pericardial effusion was diagnosed by echocardiography and pericardiocentesis was done in the cardiac catheterization room. Patients were followed up 3 monthly for 1 year and reassessed clinically and by echocardiography. Results: Patients presenting with pericardial effusion belonged to the age group of 8 to 88 years. The most common etiology was tuberculosis (36.5%) followed by malignancy (19%) and idiopathic/Viral (12.6%). Among malignancies, carcinoma lung was the most common cause followed by lymphoma. Pericardiocentesis was done in 46 patients (73%) and the approach was subxiphoid. The procedure-related complications were in 4 patients (6.3%) and there was no death as a consequence of the procedure. The total mortality was 12 (19%) with in-hospital death of 6 patients (9.5%). Conclusions: The study showed tuberculosis as the most common cause of pericardial effusion in developing countries like Nepal and as a cause of cardiac tamponade in contrast to the studies from the developed world where malignancy remains the leading cause.展开更多
Group A streptococcus (GAS) is a rare cause of purulent pericarditis in pediatric patients as only 7 cases have been reported. We present a 10-month-old boy who developed cardiac tamponade from GAS and was successfull...Group A streptococcus (GAS) is a rare cause of purulent pericarditis in pediatric patients as only 7 cases have been reported. We present a 10-month-old boy who developed cardiac tamponade from GAS and was successfully treated with subxiphoid tube drainage and 4 weeks of antibiotics at the Children’s Hospital of Philadelphia.展开更多
This article intends to report a rare case of massive pericardial effusion as the first manifestation of hypothyroidism. A 45-year-old male patient, accompanied by a cardiology department, suddenly started to present ...This article intends to report a rare case of massive pericardial effusion as the first manifestation of hypothyroidism. A 45-year-old male patient, accompanied by a cardiology department, suddenly started to present signs of dyspnea and tiredness. He was submitted to an echocardiogram and diagnosed with dilated cardiomyopathy associated with a moderate pericardial effusion and low ejection of fraction. The laboratory tests showed elevated TSH levels （13.20 mIU/L）, what leads to the hypothyroidism diagnose and enable to start the treatment with levothyroxine. The patient has not followed correctly the treatment, reason why he has not showed any improves. He was admitted in the hospital to cardiology monitoring and the chest radiography confirmed an intense pericardial effusion. Then, the patient was submitted to the pericardiocentesis procedure, which was capable of remove the pericardial fluid for laboratory analysis and fragment of the pericardial sac for neoplastic cell research. After the hospital discharge, he was maintained in outpatient follow-up, when showed an important improvement in the clinical state.展开更多
文摘Background: Pericardial effusion may progress to cardiac tamponade when pressure around the heart increases to a level comparable to that of the right and left atria. Patients with cardiac tamponade need timely completion of emergency pericardiocentesis to relieve the threat to the patient’s life, and to save valuable time for patients who need emergency thoracotomy and pericardial window drainage. Pericardiocentesis is a necessary clinical skill for residents in standardized training. In addition, nurses who are familiar with this technology can better assist clinicians to perform this operation. In order to make the medical staff quickly master the theoretical knowledge of emergency pericardiocentesis, we designed a “1 + 1 + 1” teaching method for the theoretical teaching of emergency pericardiocentesis. Objective: This study aims to explore the effectiveness of the “1 + 1 + 1” teaching method in the theoretical teaching of emergency pericardiocentesis. Methods: We used an English teaching video of emergency pericardiocentesis and applied the “1 + 1 + 1” teaching method for theoretical teaching. A questionnaire survey was conducted before and after the lecture among 19 medical staff of different years of service to understand their mastery of the theoretical content of emergency pericardiocentesis before and after the lecture. According to the years of service, the medical staff were divided into three groups: 1 - 3 years (Group A), 4 - 10 years (Group B), and over 10 years (Group C), and the changes in the mastery of various contents by the overall medical staff and each group were statistically analyzed. Results: Before the lecture, the number of people who mastered the indications, contraindications, most commonly used methods, and common complications of emergency pericardiocentesis were 15, 12, 16, and 17, respectively, whereas after the lecture, these numbers increased to 17, 19, 19, and 19, respectively. The overall mastery before and after the lecture was statistically significant (p Conclusion: The “1 + 1 + 1” teaching method can effectively improve the overall mastery level of medical staff’s theoretical knowledge of emergency pericardiocentesis, especially in improving the mastery of contraindications of this operation.
文摘AIM:To evaluate the role and outcome of pericardiocentesis with intrapericardial cisplatin instillation for malignant pericardial effusion resulting from esophageal cancer. METHODS:We retrospectively studied 7 patients who underwent pericardiocentesis with intrapericardial cisplatin instillation for malignant pericardial effusion resulting from esophageal cancer.After pericardiocentesis,we performed catheterization of the pericardial space under ultrasonogram guidance.Malignant etiology of the pericardial fluid was confirmed by cytological examination.Subsequently,cisplatin(10 mg in 20 mL normal saline) was instilled into the pericardial space. RESULTS:The mean total volume of the aspirated effusion fluid was 782±264 mL(range,400-1200 mL) . The drainage catheter was successfully removed in all patients,and the mean duration of pericardial drainagewas 7.7±2.7 d(range,5-13 d) .No fluid reaccumulation was observed.Mean survival time was 120±71 d(range,68-268 d) . CONCLUSION:Pericardiocentesis along with catheter drainage appears to be a safe and effective for pericardial malignant effusion and tamponade,and cisplatin instillation prevents recurrence.
文摘BACKGROUND:Traditionally performed using a subxiphoid approach,the increasing use of point-of-care ultrasound in the emergency department has made other approaches(parasternal and apical)for pericardiocentesis viable.The aim of this study is to identify the ideal approach for emergency-physician-performed ultrasound-guided pericardiocentesis as determined by ultrasound image quality,distance from surface to pericardial fl uid,and likely obstructions or complications.METHODS:A retrospective review of point-of-care cardiac ultrasound examinations was performed in two urban academic emergency departments for the presence of pericardial eff usions.The images were reviewed for technical quality,distance of eff usion from skin surface,and predicted complications.RESULTS:A total of 166 pericardial effusions were identified during the study period.The mean skin-to-pericardial fl uid distance was 5.6 cm(95%confi dence interval[95%CI]5.2-6.0 cm)for the subxiphoid views,which was signifi cantly greater than that for the parasternal(2.7 cm[95%CI 2.5-2.8 cm],P<0.001)and apical(2.5 cm[95%CI 2.3-2.7 cm],P<0.001)views.The subxiphoid view had the highest predicted complication rate at 79.7%(95%CI 71.5%-86.4%),which was signifi cantly greater than the apical(31.9%;95%CI 21.4%-44.0%,P<0.001)and parasternal(20.2%;95%CI 12.8%-29.5%,P<0.001)views.CONCLUSIONS:Our results suggest that complication rates with pericardiocentesis will be lower via the parasternal or apical approach compared to the subxiphoid approach.The distance from skin to fl uid collection is the least in both of these views.
文摘Pericardiocentesis is a common therapeutic procedure for pericardial tamponade due to pericardial effusion as well as a diagnostic procedure to obtain fluid for cytopathologic examination.Standard methods include ultrasound or fluoroscopic guidance,which generally result in high success rates(over 95%).[1,2].The complication rate of pericardiocentesis is low with reported incidences of l%-2%.[3]In the past,the most common indications for pericardiocentesis include uremia,tuberculous pericarditis or malignant pericardial effusions.However,with the increasing number of catheter-based interventional cardiac procedures,iatrogenic pericardial effusions are becoming more frequent[4-6].
文摘A 72-year-old female was admitted to the CCU with a recent onset of progressive breathlessness for bedside pericardial drainage for chronic pericardial effusion. After an uncomplicated drainage procedure, initially a serous straw coloured fluid was aspired with subsequent hemorrhagic aspiration with haemoglobin value similar to the peripheral blood. The patient showed initially transient improvement followed by rapid deterioration into severe shock and death. Signs of infero-posterior myocardial infarction (MI) were seen on the ECG. Before death, further interventions were refused by her and her family but a permission was given for autopsy. At autopsy, right ventricular rupture was seen with a 0.6 cm tear with a large amount of 800 cc bloody fluid with clots. The result of histopathologic study of the tear was resembling three-days old MI. The drain was found to be properly localized in the pericardial space, was not blocked and caused no harm to the myocardium. Furthermore, histopathologic examination revealed pulmonary adenocarcinoma of the left upper lobe, pleuritis and lymphangitis carcinomatosa and enlarged mediastinal lymph nodes. A case of fatal complication is reported following bedside pericardial drainage. Postmortal, right ventricular tear mimicked myocardial infarction.
文摘BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits for nonischemic chest pain in Western Europe and North America.The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes.Acute pericarditis is generally self-limited.However,some cases may be complicated by either tamponade or a large pericardial effusion,which carries a significant risk of recurrence.Risk factors for acute pericarditis include viral infections,cardiac surgery,and autoimmune disorders.A rarer cause of pericardial inflammation includes pneumonia,which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics.Purulent pericarditis carries a high fatality rate,especially in the setting of tamponade,and is invariably deadly without the administration of antibiotics.Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.CASE SUMMARY We present the case of a 62-year-old woman who sought medical attention at the emergency department(ED)due to a 5-day history of chest pain,shortness of breath,and subjective fevers.Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein.A chest X-ray revealed a new focal density within the left lower lung base,and a bedside point-of-care ultrasound showed a pericardial fluid collection.The patient was subsequently admitted,where she underwent pericardiocentesis.Fluid cultures from drainage grew streptococcus pneumoniae.She was started on broadspectrum antibiotics immediately after the procedure.The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.CONCLUSION This case report emphasizes a unique complication of community-acquired pneumonia.Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium.This condition is virtually fatal without the administration of antibiotics.Therefore,in the context of suspected pneumonia and a new pericardial fluid collection on imaging,clinicians should suspect purulent pericarditis until proven otherwise,which requires emergent intervention.
文摘BACKGROUND Development of pericardial effusion in patients with left ventricular assist devices(LVADs)can be detrimental to health outcomes.This study aims to elucidate the prevalence and risk factors for pericardial effusion in patients with LVADs.AIM To elucidate risk factors associated with the presence of pericardial effusion in patients with LVADs and compare the clinical outcomes of those with and without pericardial effusion.The secondary goal is to determine the incidence of pericardiocentesis and pericardial window placement in patients with LVADs experiencing pericardial effusion.METHODS Data were obtained from the National Inpatient Sample database between 2016 and 2018.Statistical analysis was performed using Pearsonχ2 test and multivariate logistic regression analysis to determine clinical outcomes of pericardial effusion and to identify variables associated with pericardial effusion in LVAD patients,respectively.RESULTS The prevalence of LVAD was 9850(0.01%)among total study patients(n=98112095).The incidence of pericardial effusion among LVAD patients was 640(6.5%).The prevalence of liver disease(26.6%vs 17.4%),chronic kidney disease(CKD;54.6%vs 49.4%),hypothyroidism(21.9%vs 18.1%),congestive heart failure(98.4%vs 96.5%),atrial fibrillation(Afib;58.59%vs 50.5%),coronary artery disease(CAD;11.7%vs 4.4%),dyslipidemia(31.3%vs 39.3%),and having undergone percutaneous coronary intervention(PCI;1.6%vs 0.7%)was higher in the pericardial effusion cohort vs the non-pericardial effusion cohort.Multivariate regression analysis demonstrated that CAD(OR=2.89)and PCI(OR=2.2)had the greatest association with pericardial effusion in patients with LVADs.These were followed by liver disease(OR=1.72),hypothyroidism(OR=1.2),electrolyte derangement(OR=1.2),Afib(OR=1.1),and CKD(OR=1.05).Among patients with LVADs,the median length of stay(33 days vs 27 days)and hospitalization cost(847525 USD vs 792616 USD)were significantly higher in the pericardial effusion cohort compared to the non-pericardial effusion cohort.There was no significant difference in mortality between cohorts.The prevalence of cardiac tamponade was 109(17.9%of LVAD patients with pericardial effusion).Ten(9.2%of LVAD patients with cardiac tamponade)patients underwent pericardiocentesis and 44(40.3%)received a pericardial window.CONCLUSION This study shows that liver disease,CKD,PCI,hypothyroidism,electrolyte derangement,Afib,and CAD had a significant association with pericardial effusion in LVAD patients.Hospitalization cost and length of stay were higher in the pericardial effusion group,but mortality was the same.
文摘Pericardial decompression syndrome(PDS)is an infrequent,life-threatening complication following pericardial drainage for cardiac tamponade physiology.PDS usually develops after initial clinical improvement following pericardiocentesis and is significantly underreported and may be overlooked in the clinical practice.Although the precise mechanisms resulting in PDS are not well understood,this seems to be highly associated with patients who have some underlying ventricular dysfunction.Physicians performing pericardial drainage should be mindful of the risk factors associated with the procedure including the rare potential for the development of PDS.
文摘Background: Hypothyroidism is a commonly seen condition. The presence of pericardial effusion with cardiac tamponade as initial manifestation of this endocrinological condition is very unusual. Objectives: In hypothyroidism pericardial fluid accu-mulates slowly, allowing adaptation and stretching of the pericardial sac, sometimes accommodating a large volume. Case Report: A 39 year-old female presented with chest pain, dyspnea and lower extremity edema for 1 day. Bradycardia, muffled heart sounds and severe hypertension were noticed. Chest radiograph showed an enlarged cardiac silhouette. A bedside echocardiogram revealed a cardiac tamponade, later she developed sudden hypotension and bradycardia that resolved after pericardiocentesis of 1 liter of pericardial fluid. The further laboratory evaluation revealed a TSH value of 69.3 miU/L and low T3 and free T4. The patient later developed reaccumulation of pericardial fluid with the need for creation of pericardial window. Conclusion: When the classic Beck’s triad is not present and bradycardia accompanies a cardiac tamponade, hypothyroidism should be strongly suspected. The requirement for thyroid hormone supplement is critical and is well reported. There is a chance of recurrence even after starting levothyroxine supplementation;and the associated hypertension usually requires treatment with more than one drug.
文摘Introduction: Pericardial effusion is one of the common cardiac problems in our?part of the world and adds burden to the health and economy of the country, as it is associated with high risk of morbidity and mortality. Our objective of the study was to determine the etiological spectrum of pericardial effusion, their clinical presentations and complications and assessing the usefulness of echocardiographic features of effusion in helping to determine the etiology. Methods: A cross-sectional observational prospective study of 63 patients with diagnosis of pericardial effusion was enrolled in the study. Pericardial effusion was diagnosed by echocardiography and pericardiocentesis was done in the cardiac catheterization room. Patients were followed up 3 monthly for 1 year and reassessed clinically and by echocardiography. Results: Patients presenting with pericardial effusion belonged to the age group of 8 to 88 years. The most common etiology was tuberculosis (36.5%) followed by malignancy (19%) and idiopathic/Viral (12.6%). Among malignancies, carcinoma lung was the most common cause followed by lymphoma. Pericardiocentesis was done in 46 patients (73%) and the approach was subxiphoid. The procedure-related complications were in 4 patients (6.3%) and there was no death as a consequence of the procedure. The total mortality was 12 (19%) with in-hospital death of 6 patients (9.5%). Conclusions: The study showed tuberculosis as the most common cause of pericardial effusion in developing countries like Nepal and as a cause of cardiac tamponade in contrast to the studies from the developed world where malignancy remains the leading cause.
文摘Group A streptococcus (GAS) is a rare cause of purulent pericarditis in pediatric patients as only 7 cases have been reported. We present a 10-month-old boy who developed cardiac tamponade from GAS and was successfully treated with subxiphoid tube drainage and 4 weeks of antibiotics at the Children’s Hospital of Philadelphia.
文摘This article intends to report a rare case of massive pericardial effusion as the first manifestation of hypothyroidism. A 45-year-old male patient, accompanied by a cardiology department, suddenly started to present signs of dyspnea and tiredness. He was submitted to an echocardiogram and diagnosed with dilated cardiomyopathy associated with a moderate pericardial effusion and low ejection of fraction. The laboratory tests showed elevated TSH levels （13.20 mIU/L）, what leads to the hypothyroidism diagnose and enable to start the treatment with levothyroxine. The patient has not followed correctly the treatment, reason why he has not showed any improves. He was admitted in the hospital to cardiology monitoring and the chest radiography confirmed an intense pericardial effusion. Then, the patient was submitted to the pericardiocentesis procedure, which was capable of remove the pericardial fluid for laboratory analysis and fragment of the pericardial sac for neoplastic cell research. After the hospital discharge, he was maintained in outpatient follow-up, when showed an important improvement in the clinical state.
