- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- The pericardium is a membrane surrounding the heart. It comprises an outer fibrous pericardium and an inner double-layered serous pericardium. Serous pericardium includes visceral layer and parietal ...
The pericardium is a membrane surrounding the heart. It comprises an outer fibrous pericardium and an inner double-layered serous pericardium. Serous pericardium includes visceral layer and parietal layers, separated by the pericardial cavity containing 15 to 50 ml of plasma ultra-filtrate in healthy people. The pericardium mechanically protects the heart and reduces friction between the heart. Pericardial diseases present as acute or chronic pericarditis, pericardial effusion, and cardiac tamponade. Pericarditis is a common disorder caused by inflammation of the pericardium. Acute pericarditis was reported in 5% of patients admitted to the emergency department and 0.1% to 0.2% of hospitalized patients for non-ischemic chest pain. Pericarditis can be divided into non-constructive and constrictive pericarditis. Pericarditis is commonly associated with pericardial effusion that can sometimes worsen to cardiac tamponade. Cardiac tamponade is a grave condition that happens after sudden and/or excessive accumulation of fluid in the pericardial space. The state restricts the appropriate filling of the cardiac chambers, disturbing normal hemodynamics, and ultimately causing hypotension and cardiac arrest. This article reviews the etiology, signs and symptoms, diagnosis, and management of pericarditis and cardiac tamponade.
- Successful repair of coronary sinus rupture presenting as cardiac tamponade following blunt chest trauma. [Journal Article]
- ICInteract Cardiovasc Thorac Surg 2018 Dec 01
- The isolated coronary sinus (CS) rupture causing cardiac tamponade following blunt chest trauma is a very rare and very unique traumatic form of cardiac tamponade. Prompt recognition of this injury i...
The isolated coronary sinus (CS) rupture causing cardiac tamponade following blunt chest trauma is a very rare and very unique traumatic form of cardiac tamponade. Prompt recognition of this injury is crucial for patient survival. CS injuries are frequently difficult to repair and are potentially lethal. A meticulous repair carried out on an arrested, empty and well-protected heart is recommended to achieve secure haemostasis and CS patency. To our knowledge, this is the first report on the successful repair of isolated CS rupture following blunt chest trauma.
- National Trends and Procedural Complications from Endomyocardial Biopsy: Results from the National Inpatient Sample, 2007-2014. [Journal Article]
- CCardiology 2018 Dec 05; 141(3):125-131
- CONCLUSIONS: There has been an increase in the number of EMB procedures in the US in recent years. Though the overall risk of CTRPD is very low, the risk is significantly higher in cohort 1, women, and in nonteaching hospitals. The study results provide data benchmarks for assessing EMB outcomes in the US.
- Successful Treatment of Cardiac Tamponade with Corticosteroids After Surgical Myocardial Revascularization: Case Report. [Journal Article]
- MAMed Arch 2018; 72(4):285-288
- CONCLUSIONS: A large pericardial effusion with the signs of tamponade verified by echocardiography and computerized tomography, in hemodynamically stable patient, and in the inability to evacuate the same by fenestration, was treated successfully with corticosteroids.
- Uremic Pericarditis: Distinguishing Features in a Now-Uncommon Clinical Syndrome. [Journal Article]
- SMSouth Med J 2018; 111(12):754-757
- We present the case of a 47-year-old man with a history of diabetes mellitus and diabetic nephropathy who was admitted to our hospital with acute uremic myopericarditis. Echocardiography demonstrated...
We present the case of a 47-year-old man with a history of diabetes mellitus and diabetic nephropathy who was admitted to our hospital with acute uremic myopericarditis. Echocardiography demonstrated a fibrinous pericardial effusion. The patient was initiated on hemodialysis for hyperkalemia, metabolic acidosis, and uremia. He subsequently developed shock from cardiac tamponade, which required emergent pericardiocentesis. He was notably without tachycardia while he was hypotensive, and his admission electrocardiogram did not show typical ST- or PR-segment changes typically associated with acute pericarditis. This case highlights important differences between uremic pericarditis and other prevalent types of acute pericarditis, including the lack of tachycardia during tamponade and normal electrocardiography. Uremic pericarditis is now a less common diagnosis. It is often seen in the setting of previously undiagnosed advanced kidney disease or when patients are ineffectively dialyzed. Given its atypical features, low incidence, and adverse attendant complications, internists must maintain a high degree of suspicion to correctly diagnose acute uremic pericarditis.
- Physical Diagnosis of Cardiac Tamponade. [Letter]
- AJAm J Med 2018; 131(12):e504
- Outcomes of Surgical Ablation in Patients with Atrial Fibrillation Undergoing Cardiac Surgeries. [Journal Article]
- ATAnn Thorac Surg 2018 Nov 24
- CONCLUSIONS: In this large analysis of almost 50,000 subjects with AF undergoing cardiac surgery, surgical ablation appears to be safe in the short term. Future studies should focus on evaluating the long term effectiveness of this procedure.
- Blunt trauma-induced pericardial tamponade after video-assisted thoracoscopic surgery. [Journal Article]
- ATAnn Thorac Surg 2018 Nov 24
- We report a case of blunt cardiac injury and pericardial tamponade following video-assisted thoracoscopic surgery (VATS) in a lung cancer patient with hypertension and cardiac hypertrophy. Anatomical...
We report a case of blunt cardiac injury and pericardial tamponade following video-assisted thoracoscopic surgery (VATS) in a lung cancer patient with hypertension and cardiac hypertrophy. Anatomical findings included massive hemorrhage in the pericardium, cardiac hypertrophy, and a superficial contusion with a ruptured blood vessel on the epicardium at the lateral wall of the left ventricle. The patient died of pericardial tamponade due to blunt trauma from the tip of the thoracoscopic instrument. This case suggests that detailed assessment of the cardiovascular system, especially cardiac hypertrophy, careful preparation before surgery and careful monitoring of postoperative conditions are important.
- Usefulness of Oximetry Paradoxus to Diagnose Cardiac Tamponade. [Journal Article]
- AJAm J Cardiol 2018 Nov 06
- Although echocardiography is usually diagnostic of cardiac tamponade, it may not be readily available at the point-of-care. We sought to develop and validate a measurement of respirophasic variation ...
Although echocardiography is usually diagnostic of cardiac tamponade, it may not be readily available at the point-of-care. We sought to develop and validate a measurement of respirophasic variation in the amplitude of pulse oximetry plethysmographic waveforms as a diagnostic tool for cardiac tamponade. Pulse oximetry plethysmographic waveforms were recorded, and the ratio of maximum-to-minimum measured amplitude of these waveforms from one respiratory cycle was calculated by blinded observers. Ratios from 3 consecutive respiratory cycles were then averaged to derive an "oximetry paradoxus" ratio. Cardiac tamponade was independently confirmed or excluded according to a "blinded" objective interpretation of echocardiography or right heart catheterization. Seventy four subjects were enrolled (51% men; mean age 54 ± 15 years); 19 of whom had cardiac tamponade. Oximetry paradoxus area under the curve for diagnosis of cardiac tamponade was 0.90 (95% confidence interval, 0.84 to 0.97); its diagnostic performance was superior to sphygmomanometer-measured pulsus paradoxus (area under the curve difference = 0.16, p = 0.022). In a derivation cohort (n = 37; tamponade, 9 cases), 3 diagnostic oximetry paradoxus thresholds were identified and validated in an independent validation cohort (n = 37; tamponade, 10 cases): 1.2 (100% sensitivity, 44% specificity), 1.5 (80% sensitivity, 81% specificity), and 1.7 (80% sensitivity, 89% specificity). Furthermore, oximetry paradoxus was significantly reduced after draining pericardial fluid. In conclusion, we defined and validated oximetry paradoxus as a simple and ubiquitous point-of-care test to diagnose cardiac tamponade using respirophasic changes in pulse plethysmography waveforms. This test can aid in identifying patients with cardiac tamponade, thus expediting confirmatory testing and life-saving treatment.
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- EHEur Heart J 2018 Nov 22