Diagnosis and Management of Pericardial Effusion
Total Page:16
File Type:pdf, Size:1020Kb

Load more
Recommended publications
-
Letters to the Editor
letters to the Editor Porphyria, Cardiopulmonary Bypass, and heart with additional hemorrhage into the pericardial sac (5). Peri- cardiocentesis, however, can be a temporizing measure in the se- Volatile Anesthetics verely compromised patient (4,7,8) until definitive surgical estab- lishment of a pericardial window. A pericardial window can be To the Editor: established under local anesthesia (9) via the subxiphoid or lateral We take issue with Stevens et al’s contentious statements in their thoracotomy approach (1,2,5,8,9). The subxiphoid approach is less discussion of volatile anesthetics in the patient with acute intermit- useful for trauma because limited surgical exposure may preclude tent porphyria undergoing mitral valve replacement (1). repair of cardiac wounds (2). However, a pericardial window dur- In the “pre-propofol” era, the safe and appropriate use of halo- ing awake lateral thoracotomy may be both poorly tolerated and thane and isoflurane in porphyric patients was established (2). dangerous in the distressed, moving patient (7). Recent reports of the successful use of isoflurane in porphyric A blunt trauma victim (2) recently presented for an emergent patients undergoing cardiac surgery also exist (3,4). As the authors surgical pericardial window for recurrent acute pericardial tampon- themselves allude to a report of elevated porphyrins after propofol ade. Although the patient was not hypotensive, jugular venous anesthesia in acute intermittent porphyria, favoring propofol over distention, pulsus paradoxus (1,3,7), patient distress (4), and echo- inhaled anesthetics because of the latter’s implied lack of a “safety cardiographic signs were present. As an alternative to endotracheal record” cannot be supported. -
Comparative Cardiac Anatomy
5 Comparative Cardiac Anatomy ALEXANDER J. HILL, PhD AND PAUL A. IAIZZO, PhD CONTENTS HISTORICAL PERSPECTIVE OF ANATOMY AND ANIMAL RESEARCH IMPORTANCE OF ANATOMY AND ANIMAL RESEARCH LARGE MAMMALIANCOMPARATIVE CARDIAC ANATOMY REFERENCES 1. HISTORICAL PERSPECTIVE the dominion of man and, although worthy of respect, could be OF ANATOMY AND ANIMAL RESEARCH used to obtain information if it was for a "higher" purpose (2). Anatomy is one of the oldest branches of medicine, with his- Descartes described humans and other animals as complex torical records dating back at least as far as the 3rd century BC; machines, with the human soul distinguishing humans from animal research dates back equally as far. Aristotle (384-322 BC) all other animals. This beast-machine concept was important studied comparative animal anatomy and physiology, and for early animal researchers because, if animals had no souls, Erasistratus of Ceos (304-258 BC) studied live animal anatomy it was thought that they could not suffer pain. Furthermore, the and physiology (1). Galen of Pergamum (129-199 AD) is prob- reactions of animals were thought to be the response of auto- ably the most notable early anatomist who used animals in mata and not reactions of pain (2). research to attempt to understand the normal structure and The concept of functional biomedical studies can probably function of the body (2). He continuously stressed the cen- be attributed to another great scientist and anatomist, William trality of anatomy and made an attempt to dissect every day Harvey (1578-1657 AD). He is credited with one of the most because he felt it was critical to learning (3). -
Guidelines on the Diagnosis and Management of Pericardial
European Heart Journal (2004) Ã, 1–28 ESC Guidelines Guidelines on the Diagnosis and Management of Pericardial Diseases Full Text The Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology Task Force members, Bernhard Maisch, Chairperson* (Germany), Petar M. Seferovic (Serbia and Montenegro), Arsen D. Ristic (Serbia and Montenegro), Raimund Erbel (Germany), Reiner Rienmuller€ (Austria), Yehuda Adler (Israel), Witold Z. Tomkowski (Poland), Gaetano Thiene (Italy), Magdi H. Yacoub (UK) ESC Committee for Practice Guidelines (CPG), Silvia G. Priori (Chairperson) (Italy), Maria Angeles Alonso Garcia (Spain), Jean-Jacques Blanc (France), Andrzej Budaj (Poland), Martin Cowie (UK), Veronica Dean (France), Jaap Deckers (The Netherlands), Enrique Fernandez Burgos (Spain), John Lekakis (Greece), Bertil Lindahl (Sweden), Gianfranco Mazzotta (Italy), Joa~o Morais (Portugal), Ali Oto (Turkey), Otto A. Smiseth (Norway) Document Reviewers, Gianfranco Mazzotta, CPG Review Coordinator (Italy), Jean Acar (France), Eloisa Arbustini (Italy), Anton E. Becker (The Netherlands), Giacomo Chiaranda (Italy), Yonathan Hasin (Israel), Rolf Jenni (Switzerland), Werner Klein (Austria), Irene Lang (Austria), Thomas F. Luscher€ (Switzerland), Fausto J. Pinto (Portugal), Ralph Shabetai (USA), Maarten L. Simoons (The Netherlands), Jordi Soler Soler (Spain), David H. Spodick (USA) Table of contents Constrictive pericarditis . 9 Pericardial cysts . 13 Preamble . 2 Specific forms of pericarditis . 13 Introduction. 2 Viral pericarditis . 13 Aetiology and classification of pericardial disease. 2 Bacterial pericarditis . 14 Pericardial syndromes . ..................... 2 Tuberculous pericarditis . 14 Congenital defects of the pericardium . 2 Pericarditis in renal failure . 16 Acute pericarditis . 2 Autoreactive pericarditis and pericardial Chronic pericarditis . 6 involvement in systemic autoimmune Recurrent pericarditis . 6 diseases . 16 Pericardial effusion and cardiac tamponade . -
Comparison of Traditional and Plethysmographic Methods for Measuring Pulsus Paradoxus
ARTICLE Comparison of Traditional and Plethysmographic Methods for Measuring Pulsus Paradoxus Jeff A. Clark, MD, FAAP; Mary Lieh-Lai, MD, FAAP; Ron Thomas, PhD; Kalyani Raghavan, MD; Ashok P. Sarnaik, MD, FAAP, FCCM Background: In the evaluation of patients with acute (PPpleth) on the pulse oximeter. Mean difference and asthma, pulsus paradoxus (PP) is an objective and non- 95% confidence intervals were calculated for each invasive indicator of the severity of airway obstruction. method. The 2 methods were also analyzed for correla- However, in children PP may be difficult or impossible tion and agreement using the Pearson product moment to measure. Indwelling arterial catheters facilitate the mea- correlation and a Bland and Altman plot. surement of PP, but they are invasive and generally re- served for critically ill patients. Results: Patients with status asthmaticus had higher PPausc and PPpleth readings compared with nonasthmatic pa- Objective: To determine the utility of the plethysmo- tients. Pulsus paradoxus measured by plethysmography graphic waveform (PPpleth) of the pulse oximeter in mea- in patients with and without asthma was similar to PPausc suring PP. readings (mean difference, 0.6 mm Hg; 95% confidence interval, −0.6 to 2.1 mm Hg). Individual PPpleth readings Methods: Patients from the pediatric intensive care showed significant correlation and agreement with PPausc unit, emergency department, and inpatient wards of a readings in patients both with and without asthma. tertiary care pediatric hospital were eligible for the study. A total of 36 patients (mean age [SD], 11.2 [4.7] Conclusion: Measurement of PP using the pulse oxim- years) were enrolled in the study. -
Pericardial Effusion
Pericardial Effusion ABOUT THE DIAGNOSIS are incurable, and treatment is designed to extend life and keep Pericardial effusion refers to an accumulation of fluid around the heart, the pet comfortable. Other underlying causes may be correctable, within the pericardium. The pericardium is a membranous sac that such as foreign bodies or coagulation disorders. surrounds the heart. When fluid accumulates slowly, the pericardium stretches and enlarges to accommodate the fluid, meaning that symp- TREATMENT toms are absent or delayed. A more rapid accumulation can cause If cardiac tamponade is present, the fluid must be drained promptly immediate symptoms, even with relatively small amounts of pericardial by a procedure called pericardiocentesis. Using local anesthetic, your fluid accumulation. The presence of fluid causes symptoms because veterinarian passes a catheter between the ribs into the pericardial the fluid compresses the heart and interferes with normal filling of the sac, and the fluid is drawn off. Alleviating the fluid accumulation that heart with blood. Less blood filling the heart means that less blood compresses the heart will rapidly stabilize a pet’s circulation and is pumped to the body with each heartbeat. Pericardial effusion can cardiovascular status in the vast majority of cases. Treatment then increase the external pressure on the heart to the point that delivery of depends upon the cause of the condition. If the underlying condition blood to the body is severely compromised, a condition called cardiac cannot be corrected, sometimes a procedure called pericardiectomy tamponade. Severe cardiac tamponade is a life-threatening condition. is performed. This is a surgery of the chest in which the pericardial Pericardial effusion is more common in older, large breed dogs. -
Pulsus Paradoxus
ERJ Express. Published on December 6, 2012 as doi: 10.1183/09031936.00138912 Pulsus paradoxus Olfa Hamzaoui1, Xavier Monnet2,3, Jean‐Louis Teboul2,3 1. Hôpitaux Universitaires Paris‐Sud, Hôpital Antoine Béclère, Service de Réanimation Médicale, 157, rue de la Porte de Trivaux, 92141 Clamart, France. 2. Hôpitaux Universitaires Paris‐Sud, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin‐Bicêtre, F‐94270 France. 3. Université Paris‐Sud, Faculté de médecine Paris‐Sud, EA4533, Le Kremlin‐Bicêtre, 63, rue Gabriel Péri, F‐94270 France. Address for correspondence: Prof. Jean‐Louis Teboul Service de réanimation médicale Centre Hospitalier Universitaire de Bicêtre 78, rue du Général Leclerc 94 270 Le Kremlin‐Bicêtre France e‐mail: jean‐[email protected] Phone: + 33 1 45 21 35 47 Fax: + 33 1 45 21 35 51 1 Copyright 2012 by the European Respiratory Society. Abstract Systolic blood pressure normally falls during quiet inspiration in normal individuals. Pulsus paradoxus is defined as a fall of systolic blood pressure of more than 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. -
1 SIZE, FORM, and LOCATION of the HEART FIGURE 20.2A 1. The
SIZE, FORM, AND LOCATION OF THE HEART FIGURE 20.2a 1. The heart is a cone-shaped structure that is approximately the size of a fist. 2. The apex (tip) of the heart points inferiorly, and the base of the heart is superior. Thus the cone is upside down. 3. The heart is part of the mediastinum, a partition of organs that divides the thoracic cavity into right and left halves. ANATOMY OF THE HEART Pericardium FIGURE 20.3 1. The heart is enclosed by a double-layered sac called the pericardium, or the pericardial sac. The pericardium has two main parts. A. The outer fibrous pericardium consists of connective tissue and is responsible for the strength of the pericardium. B. The inner serous pericardium is simple squamous epithelium that secretes serous fluid. It protects the heart against friction. The serous pericardium has two parts. 1) The visceral pericardium is in contact with the heart. 2) The parietal pericardium is in contact with the fibrous pericardium. 3) The pericardial cavity in-between the visceral and parietal pericardium is filled with pericardial fluid. 2. Pericarditis is inflammation of the pericardium that can cause substernal pain. It can be caused by infections or damage caused by radiation treatment for cancer. 3. Cardiac tamponade [tam-po-nAd′] is compression of the heart due to an accumulation of fluid in the pericardial space. Decreased venous input results in decreased output and death can result. Cardiac tamponade can be caused by pericarditis (build up of pericardial fluid) or wounds, such as stab or gunshot wounds (buildup of blood). -
Pericardial Effusion and Pericardiocentesis
Review http://dx.doi.org/10.4070/kcj.2012.42.11.725 Print ISSN 1738-5520 • On-line ISSN 1738-5555 Korean Circulation Journal Pericardial Effusion and Pericardiocentesis: Role of Echocardiography Hae-Ok Jung, MD Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea Pericardial effusion can develop from any pericardial disease, including pericarditis and several systemic disorders, such as malignancies, pulmonary tuberculosis, chronic renal failure, thyroid diseases, and autoimmune diseases. The causes of large pericardial effusion requiring invasive pericardiocentesis may vary according to the time, country, and hospital. Transthoracic echocardiography is the most important tool for diagnosis, grading, the pericardiocentesis procedure, and follow up of pericardial effusion. Cardiac tamponade is a kind of cardio- genic shock and medical emergency. Clinicians should understand the tamponade physiology, especially because it can develop without large pericardial effusion. In addition, clinicians should correlate the echocardiographic findings of tamponade, such as right ventricular collapse, right atrial collapse, and respiratory variation of mitral and tricuspid flow, with clinical signs of clinical tamponade, such as hypo- tension or pulsus paradoxus. Percutaneous pericardiocentesis has been the most useful procedure in many cases of large pericardial effu- sion, cardiac tamponade, or pericardial effusion of unknown etiology. The procedure should be performed with the guidance of echocardiog- raphy. (Korean Circ J 2012;42:725-734) KEY WORDS: Pericardial effusions; Echocardiography; Cardiac tamponade; Pericardiocentesis. Introduction ricardium. Pericardial fluid acts as a lubricant between the heart and the pericardium. Excess fluid or blood accumulation in this cavity is Normal pericardium is a double-walled sac that contains the heart called pericardial effusion.4)5) and the roots of the great vessels. -
Pericardial Disease and Other Acquired Heart Diseases
Royal Brompton & Harefield NHS Foundation Trust Pericardial disease and other acquired heart diseases Sylvia Krupickova Exam oriented Echocardiography course, 4th November 2016 Normal Pericardium: 2 layers – fibrous - serous – visceral and parietal layer 2 pericardial sinuses – (not continuous with one another): • Transverse sinus – between in front aorta and pulmonary artery and posterior vena cava superior • Oblique sinus - posterior to the heart, with the vena cava inferior on the right side and left pulmonary veins on the left side Normal pericardium is not seen usually on normal echocardiogram, neither the pericardial fluid Acute Pericarditis: • How big is the effusion? (always measure in diastole) • Where is it? (appears first behind the LV) • Is it causing haemodynamic compromise? Small effusion – <10mm, black space posterior to the heart in parasternal short and long axis views, seen only in systole Moderate – 10-20 mm, more than 25 ml in adult, echo free space is all around the heart throughout the cardiac cycle Large – >20 mm, swinging motion of the heart in the pericardial cavity Pericardiocentesis Constrictive pericarditis Constriction of LV filling by pericardium Restriction versus Constriction: Restrictive cardiomyopathy Impaired relaxation of LV Constriction versus Restriction Both have affected left ventricular filling Constriction E´ velocity is normal as there is no impediment to relaxation of the left ventricle. Restriction E´ velocity is low (less than 5 cm/s) due to impaired filling of the ventricle (impaired relaxation) -
Constriction Versus Restriction Anurag Bajaj. MD Regional Health
10/21/2019 Constriction versus Restriction Anurag Bajaj. MD Regional Health Recognizing constrictive pericarditis and restrictive cardiomyopathy as a reversible cause of heart failure. Understand the pathophysiology of constrictive pericarditis and restrictive cardiomyopathy. Echocardiographic findings differentiating between constrictive pericarditis and restrictive cardiomyopathy. Invasive hemodynamics findings differentiating between constrictive pericarditis and restrictive cardiomyopathy. 1 10/21/2019 A 45-year-old man is evaluated for a 6-month history of progressive dyspnea on exertion and lower- extremity edema. He can now walk only one block before needing to rest. He reports orthostatic dizziness in the last 2 weeks. He was diagnosed 15 years ago with non-Hodgkin lymphoma, which was treated with chest irradiation and chemotherapy and is now in remission. He also has type 2 diabetes mellitus. He takes furosemide (80 mg, 3 times daily), glyburide, and low-dose aspirin. Physical examination Afebrile. Blood pressure of 125/60 mm Hg supine and 100/50 mm Hg standing; pulse is 90/min supine and 110/min standing. Respiration rate is 23/min. BMI is 28. Presence of jugular venous distention and jugular venous engorgement with inspiration. CVP of 15 cm H2O. Cardiac examination discloses diminished heart sounds and a prominent early diastolic sound but no gallops or murmurs. Pulmonary auscultation discloses normal breath sounds and no crackles. Abdominal examination shows shifting dullness Lower extremities show 3+ pitting edema to the level of the knees. Remainder of the physical examination is normal. BUN 40 mg/dL, Cr 2.0 mg/dL, ALT 130 U/L, AST 112 U/L, Albumin 3.0 g/dL, UA negative for protein, 2 10/21/2019 70 year old female presented with dyspnea caused by minor stress. -
Cardiac Tamponade Management Clinical Guideline
Cardiac Tamponade Management Clinical Guideline V1.0 August 2020 Summary Cardiac Tamponade Management Clinical Guideline V1.0 Page 2 of 20 1. Introduction 1.1 Cardiac tamponade is a clinical syndrome caused by the accumulation of fluid, blood, pus, clots or gas in the pericardial space, resulting in reduced ventricular filling and subsequent haemodynamic compromise. This includes a haemodynamic spectrum ranging from incipient or preclinical tamponade (when pericardial pressure equals right atrial pressure but it is lower than left atrial pressure) to haemodynamic shock with significant reduction of stroke volume and blood pressure, the latter representing a life-threatening medical emergency. 1.2 The diagnosis of cardiac tamponade is essentially a clinical diagnosis requiring echocardiographic confirmation of the initial diagnostic suspicion. In most patients, cardiac tamponade should be diagnosed by clinical examination that typically shows elevated systemic venous pressure, tachycardia, muffled heart sounds and paradoxical arterial pulse. Systemic blood pressure may be normal, decreased, or even elevated. Clinical signs may also include decreased electrocardiographic voltage with electrical alternans and an enlarged cardiac silhouette on chest X-ray with slow-accumulating effusions. 1.3 Once a clinical diagnosis of tamponade is suspected, an echocardiogram should be performed without delay. The diagnosis is then confirmed by echocardiographic demonstration of several 2D and Doppler-based findings (i.e. evidence of pericardial effusion with variable cardiac chambers’ compression, abnormal respiratory variation in tricuspid and mitral valve flow velocities, inferior vena cava plethora). 1.4 This should immediately trigger On-call Consultant Cardiologist review in order to stratify the patient risk, identify specific supportive and monitoring requirements and guide the optimal timing and modality of pericardial drainage. -
Acute Non-Specific Pericarditis R
Postgrad Med J: first published as 10.1136/pgmj.43.502.534 on 1 August 1967. Downloaded from Postgrad. med. J. (August 1967) 43, 534-538. CURRENT SURVEY Acute non-specific pericarditis R. G. GOLD * M.B., B.S., M.RA.C.P., M.R.C.P. Senior Registrar, Cardiac Department, Brompton Hospital, London, S.W.3 Incidence neck, to either flank and frequently through to the Acute non-specific pericarditis (acute benign back. Occasionally pain is experienced on swallow- pericarditis; acute idiopathic pericarditis) has been ing (McGuire et al., 1954) and this was the pre- recognized for over 100 years (Christian, 1951). In senting symptom in one of our own patients. Mild 1942 Barnes & Burchell described fourteen cases attacks of premonitory chest pain may occur up to of the condition and since then several series of 4 weeks before the main onset of symptoms cases have been published (Krook, 1954; Scherl, (Martin, 1966). Malaise is very common, and is 1956; Swan, 1960; Martin, 1966; Logue & often severe and accompanied by listlessness and Wendkos, 1948). depression. The latter symptom is especially com- Until recently Swan's (1960) series of fourteen mon in patients suffering multiple relapses or patients was the largest collection of cases in this prolonged attacks, but is only partly related to the country. In 1966 Martin was able to collect most length of the illness and fluctuates markedly from of his nineteen cases within 1 year in a 550-bed day to day with the patient's general condition. hospital. The disease is thus by no means rare and Tachycardia occurs in almost every patient at warrants greater attention than has previously some stage of the illness.