A Case of Biventricular Failure after Pericardial Window for Large Pericardial Effusion

2015 ◽  
Vol 18 (1) ◽  
pp. 036 ◽  
Author(s):  
Michael M. Koerner ◽  
Mahboob Alam ◽  
Aly El-Banayosy ◽  
Arunima Misra ◽  
Matthew J. Wall, Jr ◽  
...  
Keyword(s):  
Cardiac Tamponade ◽  
Case Reports ◽  
Systolic Dysfunction ◽  
Case Series ◽  
Pericardial Tamponade ◽  
Pericardial Window ◽  
Hemodynamic Compromise ◽  
Large Pericardial Effusion ◽  
Biventricular Failure ◽  
Large Case Series

Pericardial tamponade resulting in hemodynamic compromise requiring either pericardiocentesis [Vandyke 1983] or subxiphoid pericardial window has been reported in literature [Armstrong 1984]. There are no large case series, only scattered case reports. Cardiac tamponade is known to affect the diastolic function of the heart but rare reports have documented systolic impairment of the left and right ventricle in the setting of tamponade [Vandyke 1983; Armstrong 1984]. We report a case of a transient biventricular systolic dysfunction in a patient with early cardiac tamponade after surgical drainage of pericardia1 effusion.

scholarly journals Pericardial effusion and cardiac tamponade requiring pericardial window in an otherwise healthy 30-year-old patient with COVID-19: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Christina Walker ◽  
Vincent Peyko ◽  
Charles Farrell ◽  
Jeanine Awad-Spirtos ◽  
Matthew Adamo ◽  
...  
Keyword(s):  
Case Report ◽  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Case Reports ◽  
Healthy Woman ◽  
Signs And Symptoms ◽  
Rare Presentation ◽  
Pericardial Window ◽  
Acute Pericarditis ◽  
Novel Coronavirus

Abstract Background This case report demonstrates pericardial effusion, acute pericarditis, and cardiac tamponade in an otherwise healthy woman who had a positive test result for coronavirus disease 2019. Few case reports have been documented on patients with this presentation, and it is important to share novel presentations of the disease as they are discovered. Case presentation A Caucasian patient with coronavirus disease 2019 returned to the emergency department of our hospital 2 days after her initial visit with worsening chest pain and shortness of breath. Imaging revealed new pericardial effusion since the previous visit. The patient became hypotensive, was taken for pericardial window for cardiac tamponade with a drain placed, and was treated for acute pericarditis. Conclusion Much is still unknown about the implications of coronavirus disease 2019. With the novel coronavirus disease 2019 pandemic, research is still in process, and we are slowly learning about new signs and symptoms of the disease. This case report documents a lesser-known presentation of a patient with coronavirus disease 2019 and will help to further understanding of a rare presentation.

scholarly journals US Database Study of Clinical Burden and Unmet Need in Recurrent Pericarditis

2021 ◽  
Author(s):  
Allan Klein ◽  
Paul Cremer ◽  
Apostolos Kontzias ◽  
Muhammad Furqan ◽  
Ryan Tubman ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Treatment Response ◽  
Constrictive Pericarditis ◽  
Unmet Need ◽  
Recurrent Pericarditis ◽  
Pericardial Window ◽  
Clinical Burden ◽  
Large Pericardial Effusion ◽  
Multiple Recurrences

Background Patients with recurrent pericarditis (RP) may develop complications, multiple recurrences, or inadequate treatment response. This study aimed to characterize disease burden and unmet needs in RP. Methods and Results This retrospective US database analysis included newly diagnosed patients with RP with ≥24 months of continuous history following their first pericarditis episode. RP was defined as ≥2 pericarditis episodes ≥28 days apart. Some patients had ≥2 recurrences, while others had a single recurrence with a serious complication, ie, constrictive pericarditis, cardiac tamponade, or a large pericardial effusion with pericardiocentesis/pericardial window. Among these patients with multiple recurrences and/or complications, some had features relating to treatment history, including long‐term corticosteroid use (corticosteroids started within 30 days of flare, continuing ≥90 consecutive days) or inadequate treatment response (pericarditis recurring despite corticosteroids and/or colchicine, or other drugs [excluding NSAIDs] within 30 days of flare, or prior pericardiectomy). Patients (N=2096) had hypertension (60%), cardiomegaly (9%), congestive heart failure (17%), atrial fibrillation (16%), autoimmune diseases (18%), diabetes mellitus (21%), renal disease (20%), anxiety (21%), and depression (14%). Complications included pericardial effusion (50%), cardiac tamponade (9%), and constrictive pericarditis (4%). Pharmacotherapy included colchicine (51%), NSAIDs (40%), and corticosteroids (30%), often in combination. This study estimates 37 000 US patients with RP; incidence was 6.0/100 000/year (95% CI, 5.6‒6.3), and prevalence was 11.2/100 000 (95% CI, 10.6‒11.7). Conclusions Patients with RP may have multiple recurrences and/or complications, often because of inadequate treatment response and persistent underlying disease. Corticosteroid use is frequent despite known side‐effect risks, potentially exacerbated by prevalent comorbidities. Substantial clinical burden and lack of effective treatments underscore the high unmet need.

scholarly journals Pathological findings in organs and tissues of patients with COVID-19: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250708
Author(s):  
Sasha Peiris ◽  
Hector Mesa ◽  
Agnes Aysola ◽  
Juan Manivel ◽  
Joao Toledo ◽  
...  
Keyword(s):  
Diffuse Alveolar Damage ◽  
Case Reports ◽  
Case Series ◽  
Organ Damage ◽  
Gi Tract ◽  
Hemodynamic Compromise ◽  
Viral Particles ◽  
Pathologic Findings ◽  
Organ Specific ◽  
Skin Biopsies

Background Coronavirus disease (COVID-19) is the pandemic caused by SARS-CoV-2 that has caused more than 2.2 million deaths worldwide. We summarize the reported pathologic findings on biopsy and autopsy in patients with severe/fatal COVID-19 and documented the presence and/or effect of SARS-CoV-2 in all organs. Methods and findings A systematic search of the PubMed, Embase, MedRxiv, Lilacs and Epistemonikos databases from January to August 2020 for all case reports and case series that reported histopathologic findings of COVID-19 infection at autopsy or tissue biopsy was performed. 603 COVID-19 cases from 75 of 451 screened studies met inclusion criteria. The most common pathologic findings were lungs: diffuse alveolar damage (DAD) (92%) and superimposed acute bronchopneumonia (27%); liver: hepatitis (21%), heart: myocarditis (11.4%). Vasculitis was common only in skin biopsies (25%). Microthrombi were described in the placenta (57.9%), lung (38%), kidney (20%), Central Nervous System (CNS) (18%), and gastrointestinal (GI) tract (2%). Injury of endothelial cells was common in the lung (18%) and heart (4%). Hemodynamic changes such as necrosis due to hypoxia/hypoperfusion, edema and congestion were common in kidney (53%), liver (48%), CNS (31%) and GI tract (18%). SARS-CoV-2 viral particles were demonstrated within organ-specific cells in the trachea, lung, liver, large intestine, kidney, CNS either by electron microscopy, immunofluorescence, or immunohistochemistry. Additional tissues were positive by Polymerase Chain Reaction (PCR) tests only. The included studies were from numerous countries, some were not peer reviewed, and some studies were performed by subspecialists, resulting in variable and inconsistent reporting or over statement of the reported findings. Conclusions The main pathologic findings of severe/fatal COVID-19 infection are DAD, changes related to coagulopathy and/or hemodynamic compromise. In addition, according to the observed organ damage myocarditis may be associated with sequelae.

Abstract 16344: Pericardial Complications in Patients With COVID-19: A Systematic Review of Published Cases

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sandeep Singh ◽  
Akhil Jain ◽  
Priyanka Chaudhari ◽  
Faizan Ahmad Malik ◽  
Virmitra Desai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Troponin I ◽  
Case Reports ◽  
Cardiac Injury ◽  
Pericardial Tamponade ◽  
Time Interval ◽  
Cardiac Damage ◽  
St Segment Elevation

Introduction: COVID-19 has been linked to cardiac damage and life-threatening pericardial complication on which data are trivial which incited us to perform this review of published case reports. Methods: PubMed/Medline, Web of Science and SCOPUS were searched until June 2020 for case reports on COVID-19-associated pericarditis, cardiac tamponade or pericardial effusion. Results: We identified 8 articles reporting 11 COVID-19 positive cases [mean age: 51.4±14.3 (34-78 yrs) 5 male/6 female)] with pericardial complications. All (100%) cases were COVID-19 positive at the presentation with ~80% having dyspnea, chest pain and cough. Time interval from first symptom to pericardial effusion was 7±8 (1-26) days. Five patients reported heart failure with reduced EF on echocardiography with mean LVEF 36.25%±8.54%. All patients showed nearly normal Troponin-I without angiographically significant stenosis except one. Out of 8 cases on echocardiography 4 cases reported with diffuse hypokinesia, 2 reported inferior and inferolateral walls hypokinesia and 2 reported signs of pericardial tamponade. Out of 11 patients, cardiovascular risk factors in the form of diabetes or hypertension or obesity were present in 5 patients. Cardiovascular comorbidities such as heart failure with low ejection fraction, non-ischemic cardiomyopathy and prior myocarditis were present in 3 patients. ST-segment elevation in 3, sinus tachycardia in 2, T wave inversion in 1 case were noted. Four patients developed cardiac tamponade, 1 developed takotsubo syndrome and 3 patients died. Conclusions: COVID-19 patients had signs of a high burden of cardiac injury. Pericardial complications (pericardial effusion and cardiac tamponade) remain infrequent complications which may require prompt care to avoid mortality.

scholarly journals ECMO in Poisoning

2017 ◽  
Vol 01 (02) ◽  
pp. 82-88
Author(s):  
Vivek Gupta ◽  
Gurpreet S. Wander
Keyword(s):  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Case Reports ◽  
Case Series ◽  
Supportive Therapy ◽  
Tissue Perfusion ◽  
Western World ◽  
Hemodynamic Compromise ◽  
The World

AbstractSevere poisoning may lead to life-threatening situation or death due to cardiovascular dysfunction, arrhythmia, or cardiogenic shock. The poisoning substance varies in different parts of world; in the Western world, the drugs with cardiotoxic potential are more common, while pesticides and other household toxins are common in the rest of the world. However, most of these patients are relatively young and otherwise healthy irrespective of poisoning substances. Extracorporeal membrane oxygenation (ECMO) has regained interest in recent past and now its use is being explored for newer indications. The use of ECMO in poisoning has shown promising results as salvage therapy and can be used as bridge to recovery, antidote, and toxin removal with renal replacement therapy or transplant. The ECMO has been used in those poisoned patients who have persistent cardiogenic shock or refractory hypoxemia despite adequate supportive therapy. ECMO may be useful in providing adequate cardiac output and maintain tissue perfusion which helps in the redistribution of toxins from central circulation and facilitate the metabolism and excretion. However, the available literature is not sufficient and is based on case reports, case series, and retrospective cohort study. In spite of high mortality with severe poisoning and encouraging outcome with use of ECMO, it is an underutilized modality across the world. Though evidences suggest that early consideration of ECMO in severely poisoned patients with refractory cardiac arrest or hemodynamic compromise refractory to standard therapies may be beneficial, the right time to start ECMO in poisoned patients, criteria to start ECMO, and prognostication prior to initiation of ECMO is yet to be answered. Future studies and publications may address these issues, whereas the ELSO (Extracorporeal Life Support Organization) data registry may help in collecting global data on poisoning more effectively.

scholarly journals Cardiac sequelae of novel coronavirus disease 2019 (COVID-19): a clinical case series

2020 ◽  
Vol 4 (FI1) ◽  
pp. 1-6 ◽  
Author(s):  
Zachary D Demertzis ◽  
Carina Dagher ◽  
Kelly M Malette ◽  
Raef A Fadel ◽  
Patrick B Bradley ◽  
...  
Keyword(s):  
African American ◽  
Cardiac Index ◽  
Clinical Course ◽  
Case Reports ◽  
Case Series ◽  
Pulseless Electrical Activity ◽  
Inferior Wall ◽  
Takotsubo Syndrome ◽  
Troponin Elevation ◽  
Large Pericardial Effusion

Abstract Background COVID-19 caused by severe acute respiratory syndrome coronavirus 2 most commonly manifests with fever and respiratory illness. The cardiovascular manifestations have become more prevalent but can potentially go unrecognized. We look to describe cardiac manifestations in three patients with COVID-19 using cardiac enzymes, electrocardiograms, and echocardiography. Case summaries The first patient, a 67-year-old Caucasian female with non-ischaemic dilated cardiomyopathy, presented with dyspnoea on exertion and orthopnoea 1 week after testing positive for COVID-19. Echocardiogram revealed large pericardial effusion with findings consistent with tamponade. A pericardial drain was placed, and fluid studies were consistent with viral pericarditis, treated with colchicine, hydroxychloroquine, and methylprednisolone. Follow-up echocardiograms showed apical hypokinesis, that later resolved, consistent with Takotsubo syndrome. The second patient, a 46-year-old African American male with obesity and type 2 diabetes mellitus presented with fevers, cough, and dyspnoea due to COVID-19. Clinical course was complicated with pulseless electrical activity arrest; he was found to have D-dimer and troponin elevation, and inferior wall ST elevation on ECG concerning for STEMI due to microemboli. The patient succumbed to the illness. The third patient, a 76-year-old African American female with hypertension, presented with diarrhoea, fever, and myalgia, and was found to be COVID-19 positive. Clinical course was complicated, with acute troponin elevation, decreased cardiac index, and severe hypokinesis of the basilar wall suggestive of reverse Takotsubo syndrome. The cardiac index improved after pronation and non-STEMI therapy; however, the patient expired due to worsening respiratory status. Discussion These case reports demonstrate cardiovascular manifestations of COVID-19 that required monitoring and urgent intervention.

scholarly journals Pericardial Tamponade and Elevated Serum CA-125 Level in Inadequately Treated Hypothyroidism

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Moaaz Baghal ◽  
Viralkumar Amrutiya ◽  
Bhoomi Patel ◽  
Rutwik Patel ◽  
Jonathan Hernandez ◽  
...  
Keyword(s):  
Cardiac Tamponade ◽  
Elevated Serum ◽  
Abdominal Distension ◽  
Young Female ◽  
Pericardial Tamponade ◽  
Medical Emergency ◽  
Ca 125 ◽  
Pericardial Window ◽  
Abdominal Paracentesis ◽  
Shed Light

Cardiac tamponade is a medical emergency and must be managed promptly, and reaching a diagnosis is imperative to prevent recurrence. Herein, we present a case of a young female patient that presented with progressive shortness of breath and abdominal distension and was found to have cardiac tamponade with the finding of elevation of a blood tumor marker, CA-125, in the setting of nonadherence to thyroid replacement therapy. She was managed by surgical pericardial window and abdominal paracentesis, with replacement of thyroid hormones leading to resolution of the tamponade and ascites. CA-125 elevation associated with cardiac tamponade and myxedema ascites due to hypothyroidism is very rare, and we aim to shed light on the importance of having a broad differential when approaching cardiac tamponade and understand the association between CA-125 and hypothyroidism.

scholarly journals SAT-484 Presyncope as Initial Presentation of Massive Pericardial Effusion with Tamponade in a Patient with Primary Hypothyroidism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Susan Garcia ◽  
Su Lei Tin
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Primary Hypothyroidism ◽  
Initial Presentation ◽  
Polymorphonuclear Cells ◽  
Normal Range ◽  
Pericardial Window ◽  
Large Pericardial Effusion

Abstract Presyncope as initial presentation of massive pericardial effusion with tamponade in a patient with primary hypothyroidism Background: Hypothyroidism is an endocrinologic disorder that affects multiple systems ranging from cardiovascular, central nervous system, musculoskeletal, etc. One of the possible cardiovascular complications of hypothyroidism is pericardial effusion which is only rarely associated with tamponade. In this case report we have a 49 years old woman who presented with impending pericardial tamponade secondary to chronic primary hypothyroidism. Clinical case: A 49 years old woman with history of hypothyroidism presented to the hospital on account of headache, dizziness with presyncope episode, generalized weakness and shortness of breath for 7 days, physical exam showed normal vital signs, distant heart sounds, laboratory tests showed TSH:29.5 uIU/mL (normal range 0.270- 0.4200 uIU/mL), fT4: <0.1ng/dL (normal range 0.9–1.8 ng/dL), fT3: 1.68 pg/mL (normal range 1.80–4.60 pg/mL. Electrocardiogram showed low voltage QRS, chest CT showed large pericardial effusion with findings suggestive of right heart failure, Echocardiogram showed left ventricular dysfunction and large pericardial effusion. The patient was taken to the operating room for emergent pericardial window creation with pericardiectomy and was admitted to the Cardiac Care Unit for management of tamponade status post pericardial window. Levothyroxine 150 mcg, Liothyronine 25 mcg and Hydrocortisone 50 mg were started, the steroid was discontinued after adrenal insufficiency was ruled out. The pericardial drain was removed after 8 days and repeated tests showed TSH: 13.1 uIU/mL, fT3: 3.37 pg/mL, fT4: 0.5 ng/dL, studies of pericardial fluid only showed polymorphonuclear cells. The patient’s symptoms resolved and she was discharged on Levothyroxine 150 mcg and Liothyronine 25 mcg. During follow up visits the thyroid function tests were normal, Liothyronine was discontinued and a repeated Echocardiogram showed normal systolic function. Conclusions: Pericardial effusion can be found in 3–30% of patients with hypothyroidism but only in very rare cases (less than 3%) is associated with cardiac tamponade and occurs when there is a severe underlying condition like myxedema coma or prolonged untreated hypothyroidism (1). It is important not to miss that dizziness and presyncope in a patient with hypothyroidism may be a manifestation of cardiac tamponade. Once the diagnosis of hypothyroidism is made it is imperative to start treatment early as untreated hypothyroidism can cause severe cardiovascular complications but even when such are present, they can be reversible with thyroid replacement therapy. Reference: (1) Kahaly, G. and Dillmann, W. (2005). Thyroid Hormone Action in the Heart. Available at: https://academic.oup.com/edrv/article/26/5/704/2355198 [Accessed July 12 2019].

Abstract 14877: A Never Ending Tale of Pericarditis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michel Ibrahim ◽  
Michael Fattouh ◽  
Omar Siddiqi ◽  
Alice K Jacobs
Keyword(s):  
Decision Making ◽  
Case Reports ◽  
Systolic Dysfunction ◽  
Management Strategies ◽  
Interdisciplinary Team ◽  
Pericardial Tamponade ◽  
Prior History ◽  
Acute Pericarditis ◽  
History Of

Background: The evidence on recurrent pregnancy-related pericarditis is limited, and management strategies are based mainly on case reports and expert opinion. Case: A 25-year-old G2P1, 28-week pregnant female, with a history of presumed viral pericarditis complicated by pericardial tamponade and recurrent colchicine resistant pericarditis which was successfully treated with a prolonged steroid taper in the postpartum period, now 1 year in remission presents with shortness of breath and pleuritic chest pain with elevated inflammatory consistent with prior presentation of myo-pericarditis. A trans-thoracic echocardiogram (TTE) revealed a mild pericardial effusion without evidence of systolic dysfunction, and pericardial tamponade. Decision-Making: Given prior history of pregnancy related colchicine resistant pericarditis which was complicated by pericardial tamponade around her prior delivery time, it was decided by an interdisciplinary team involving rheumatology, cardiology and obstetrics, to initiate prednisone 10 mg daily. Symptoms subsequently subsided with a down trend of cardiac and inflammatory biomarkers. Daily 10 mg prednisone was to be continued up through delivery but within 2 months she presented yet again with a similar clinical picture and was diagnosed with recurrence of disease. Her prednisone was increased to 20 mg daily with symptom resolution. Two weeks later, she went into labor and received stress dose steroids. She had a normal spontaneous vaginal delivery without any complications. She continued the same dose of 20 mg of prednisone until her follow-up with rheumatology when the decision was made to initiate azathioprine and slowly titrate off the steroids. Conclusion: The case highlights not only the rare association between pregnancy and recurrent pericarditis but also the complexity of its management. The case of our patient underscores the importance of family planning, shared-decision making, and management by an interdisciplinary team comprised of rheumatology, obstetrics/gynecology, and cardiology. There are currently no known well controlled trials of therapy for pregnancy related idiopathic recurrent acute pericarditis.

Anticoagulation of Percutaneous Ventricular Assist Device Using Argatroban-Based Purge Solution: A Case Series

2017 ◽  
Vol 31 (5) ◽  
pp. 514-518 ◽  
Author(s):  
Emily C. Blum ◽  
Carolyn R. Martz ◽  
Yelena Selektor ◽  
Hassan Nemeh ◽  
Zachary R. Smith ◽  
...  
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Optimal Dosing ◽  
Therapeutic Anticoagulation ◽  
Pump Thrombosis ◽  
Purge Flow ◽  
Biventricular Failure ◽  
Effective Use

Impella devices are percutaneously inserted ventricular assist devices which require a continuous purge solution that contains heparin to prevent pump thrombosis and device failure. We describe 2 patients with heparin-induced thrombocytopenia (HIT) supported with an Impella device utilizing an argatroban-based purge solution. Case 1 involved an 83-year-old female with biventricular failure which resulted in right ventricle Impella support. The purge solution was changed to include argatroban due to concern of device clotting in the setting of HIT. Case 2 involved a 55-year-old male with worsening cardiogenic shock which resulted in left ventricle Impella support. Due to decreased purge flow rates and concerns for clotting, argatroban was added to the purge solution. Both patients’ total argatroban regimens were monitored and adjusted by pharmacy, resulting in therapeutic anticoagulation without any major bleeding or thrombotic events. Subsequently, a protocol was designed and implemented. These case reports appear to demonstrate the safe and effective use of argatroban purge solutions for the necessary anticoagulation with an Impella device. Further studies are needed to confirm these results and determine the optimal dosing regimen.

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