Cardiac tamponade secondary to Dressler’s syndrome

2021 ◽  
Vol 14 (8) ◽  
pp. e243577
Author(s):  
Stephanie Connaire ◽  
Elena Elchinova ◽  
Chiara Bucciarelli-Ducci ◽  
Philip Campbell
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Cardiac Mri ◽  
Kidney Injury ◽  
Medical Assessment ◽  
Large Pericardial Effusion ◽  
Assessment Unit ◽  
Loin Pain ◽  
The Right ◽  
High Lactate

A 56-year-old woman presented to hospital with chest pain. Following review and investigations in the medical assessment unit, she was diagnosed with costochondritis and discharged home. She represented 10 days later and was mottled and hypotensive with a high lactate, raised inflammatory markers, an acute kidney injury and bilateral loin pain. A CT of the thorax, abdomen and pelvis showed pleural effusions and a large pericardial effusion with features of cardiac tamponade on subsequent echocardiography. A pericardiocentesis was performed and she was admitted to intensive care for haemofiltration. Once the patient was stable, an inpatient cardiac MRI was requested to further investigate an enhancing pericardium and echo-bright areas in the inferior, inferoseptal and inferolateral walls of the left ventricle demonstrated on echocardiography. The cardiac MRI showed evidence of a recent infarction in the right coronary artery (RCA) territory with pericardial inflammation and a resolved pericardial effusion. Overall, the findings were in keeping with Dressler’s syndrome.

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 Pericardial Fluid in a COVID-19 Patient: Is It Exudate or Transudate?

2020 ◽  
Author(s):  
Hassan H Allam ◽  
Abdulhalim Jamal Kinsara ◽  
Tareq Tuaima ◽  
Shadwan Alfakeh
Keyword(s):  
Lactate Dehydrogenase ◽  
Pericardial Effusion ◽  
Pericardial Fluid ◽  
Case Description ◽  
Limited Information ◽  
Additional Insight ◽  
Laboratory Findings ◽  
Large Pericardial Effusion ◽  
Insight Into ◽  
High Lactate

Background: Very limited information is available on pericardial effusion as a complication of COVID-19 infection. There are no reports regarding pericardial fluid findings in COVID-19 patients. Case description: We describe a 41-year-old woman, with confirmed COVID-19, who presented with a large pericardial effusion. The pericardial fluid was drained. We present the laboratory findings to improve knowledge of this virus. Discussion: We believe this is the first such reported case. Findings suggested the fluid was exudative, with remarkably high lactate dehydrogenase and albumin levels. We hope our data provide additional insight into the diagnosis and therapeutic options for managing this infection.

scholarly journals A Case of Cardiac Tamponade in a Patient with Metastatic Renal Cell Carcinoma on Pazopanib Treatment

2020 ◽  
Vol 2020 ◽  
pp. 1-4 ◽  
Author(s):  
Vinu Sarathy ◽  
Sriniivas Belagutty Jayappa ◽  
Thianesh Waran ◽  
Radheshyam Naik
Keyword(s):  
Adverse Effect ◽  
Renal Cell Carcinoma ◽  
Pericardial Effusion ◽  
Cell Carcinoma ◽  
Cardiac Tamponade ◽  
Renal Cell ◽  
Kinase Inhibitor ◽  
Thyroid Stimulating Hormone ◽  
Large Pericardial Effusion ◽  
Inhibitor Treatment

Asymptomatic minimal pericardial effusion may be frequently found in patients with hypothyroidism. Cardiac tamponade secondary to hypothyroidism is rarely referenced in medical literature. Hypothyroidism as an adverse effect of pazopanib (tyrosine kinase inhibitor) treatment leading to cardiac tamponade is an even rarer occurrence. Here, we report an unusual case of a 71-year-old male, with a case of renal cell carcinoma on pazopanib treatment presenting with shortness of breath who was found to have hypothyroidism with a large pericardial effusion leading to cardiac tamponade. The patient did not have any prior reports of thyroid-stimulating hormone (TSH) or thyroid hormone levels at presentation. No such case of cardiac tamponade due to hypothyroidism as an adverse effect of pazopanib tablet treatment has been reported to our knowledge.

scholarly journals Cardiac tamponade and massive pleural effusion in a young COVID-19-positive adult

2021 ◽  
Vol 14 (9) ◽  
pp. e244518
Author(s):  
Dilip Johny ◽  
Kodangala Subramanyam ◽  
Nandakishore Baikunje ◽  
Giridhar Belur Hosmane
Keyword(s):  
Pleural Effusion ◽  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Low Voltage ◽  
Pericardial Fluid ◽  
Rare Presentation ◽  
Large Pericardial Effusion ◽  
Left Pleural Effusion ◽  
Dimensional Echocardiography ◽  
Cardiac Manifestations

COVID-19 has a broad spectrum of cardiac manifestations, and cardiac tamponade leading to cardiogenic shock is a rare presentation. A 30-year-old man with a history of COVID-19-positive, reverse transcription polymerase chain reaction (RT-PCR) done 1 week ago and who was home-quarantined, came to the emergency department with palpitations, breathlessness and orthopnoea. His ECG showed sinus tachycardia with low-voltage complexes, chest X-ray showed cardiomegaly and left pleural effusion and two-dimensional echocardiography showed large pericardial effusion with features suggestive of cardiac tamponade. He was taken up for emergency pericardiocentesis which showed haemorrhagic pericardial fluid. Intercostal drainage insertion was done for left-sided large pleural effusion. After ruling out all the other causes for haemorrhagic pericardial effusion, the patient was started on colchicine, steroids, ibuprofen and antibiotics to which he responded. Both pericardial and pleural effusions resolved completely on follow-up.

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].

scholarly journals Sanguineous Pericardial Effusion and Cardiac Tamponade in the Setting of Graves’ Disease: Report of a Case and Review of Previously Reported Cases

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Peter V. Bui ◽  
Sonia N. Zaveri ◽  
J. Rush Pierce Jr.
Keyword(s):  
Atrial Fibrillation ◽  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Low Voltage ◽  
Thyroid Stimulating Hormone ◽  
Ventricular Rate ◽  
Thyroid Storm ◽  
Graves Disease ◽  
Pericardial Effusions ◽  
Large Pericardial Effusion

Introduction. Pericardial effusion in the setting of hyperthyroidism is rare. We present a patient with Graves’ disease who developed a sanguineous pericardial effusion and cardiac tamponade.Case Description. A 76-year-old man presenting with fatigue was diagnosed with Graves’ disease and treated with methimazole. Two months later, he was hospitalized for uncontrolled atrial fibrillation. Electrocardiography showed diffuse low voltage and atrial fibrillation with rapid ventricular rate. Chest radiograph revealed an enlarged cardiac silhouette and left-sided pleural effusion. Thyroid stimulating hormone was undetectable, and free thyroxine was elevated. Diltiazem and heparin were started, and methimazole was increased. Transthoracic echocardiography revealed a large pericardial effusion with cardiac tamponade physiology. Pericardiocentesis obtained 1,050 mL of sanguineous fluid. The patient progressed to thyroid storm, treated with propylthiouracil, potassium iodine, hydrocortisone, and cholestyramine. Cultures and cytology of the pericardial fluid were negative. Thyroid hormone markers progressively normalized, and he improved clinically and was discharged.Discussion. We found 10 previously reported cases of pericardial effusions in the setting of hyperthyroidism. Heparin use may have contributed to the sanguineous nature of our patient’s pericardial effusion, but other reported cases occurred without anticoagulation. Sanguineous and nonsanguineous pericardial effusions and cardiac tamponade may be due to hyperthyroidism.

scholarly journals Cardiac manifestations of tuberculosis in a tertiary care center of Nepal

2018 ◽  
Vol 15 (1) ◽  
pp. 35-38
Author(s):  
Smriti Shakya ◽  
Sunil Chandra Jha
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Care Center ◽  
Tertiary Care ◽  
Pericardial Fluid ◽  
Age Group ◽  
Acute Pericarditis ◽  
Old Patients ◽  
Large Pericardial Effusion ◽  
2D Echocardiography

Background and Aims: Tuberculosis remains an important etiological cause of pericarditis and pericardial effusion in developing countries like Nepal. The objective of this study is to identify the various presentations of tuberculous pericarditis along with the demographic profile in our context and their short term outcome.Methods: We studied 53 patients from September 2015 to August 2017 regardless of age and gender who presented to Manmohan Cardiothoracic Vascular and Transplant Center with pericarditis of tubercular origin. The various manifestations of the disease were categorized with 2D echocardiography. Pericardiocentesis was done in patients with large pericardial effusion especially in cardiac tamponade and pericardiectomy done in chronic constrictive pericarditis(CCP). Antitubercular therapy with steroids was instituted.Results: Out of 53 patients, 62% were male and 38% were female. The ages ranged from 6-71 years (42±19.5). Twenty three percent of patients were from the age group 61-70yrs, 20% seen in age group 21-30 years, 8% in less than 10 yrs and 2% in above 70yrs old patients. The most common manifestation seen was large pericardial effusion (32%), followed by CCP (22.6%), 19% presented in cardiac tamponade, 2% had pyopericardium, 2% had perimyocarditis and 4% had acute pericarditis. Adenosine deaminase (ADA) was positive in 75% of the cases when pericardial fluid was tapped. Two patients developed CCP during follow up. Two patients succumbed to death during hospital stay.Conclusion: A high index of suspicion of tubercular pericarditis is inevitable in our settings where other sophisticated investigations are still lacking.Nepalese Heart Journal 2018; 15(1) 35-38

Coronary sinus diameter to inferior vena cava diameter ratio in the diagnosis of cardiac tamponade: a novel approach

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E.H Ozcan Cetin ◽  
M.S Cetin ◽  
B Tekin Tak ◽  
F.A Ekizler ◽  
F Ozcan ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Inferior Vena Cava ◽  
Cardiac Tamponade ◽  
Coronary Sinus ◽  
Inferior Vena ◽  
Vena Cava ◽  
Area Under The Curve ◽  
Right Atrial ◽  
P Value ◽  
Large Pericardial Effusion

Abstract Background and aim Coronary sinus (CS) as an intrapericardial, low-pressure, thin-walled structure can be easily compressed in cardiac tamponade. Whereas, inferior vena cava (IVC) is an extrapericardial structure which dilates in tamponade as opposed to the response of CS. The inverse relationship between these two venous structures may augment their role in the evaluation of tamponade imaging. Therefore, we assessed the usefullness of computerized tomographic measures of CS diameter, and also CS to IVC ratio (CS/IVC) to predict tamponade in clinically stable patients with large pericardial effusion. Materials and methods 66 clinically stable patients who had large pericardial effusions, were included to the study. CS diameter was measured from the point at 1 cm proximal to the CS ostium11. IVC diameter was measured from the segment between its right atrial orifice and hepatic vein. Results Patients with tamponade had 40% smaller CS diameter (5.3±1.8 vs 8.8±2.6 mm p<0.001) and 35% lower CS/IVC ratio (20.7±5.5 vs 34.7±10.5% p<0.001).After adjusting with other parameters, only either CS diameter or CS/IVC ratio predicted tamponade respectively. (Nagelkerke r square value for CS diameter was 53.7% and 72.1% for CS/IVC ratio). 1 mm increase in CS diameter and 1% increase in CS/IVC ratio were associated with an increased odds ratio of 59% and 39% in predicting tamponade, respectively (p value <0.001).In ROC analysis, a cut of value of 6.85 mm for CS diameter, had 82.6% sensitivity and 83.7% specificity for predicting cardiac tamponade (Area under the curve 0.879, p<0.001). Additionally, a cut of value of 27% for CS / IVC ratio had 87.0% sensitivity and 86.0% specificity for predicting cardiac tamponade (Area under the curve 0.945, p<0.001). Conclusion The tomographic measures of both the CS diameter and the CS/IVC ratio predicted tamponade in clinically stable patients with large pericardial effusion. Compared with CS diameter, CS/IVC ratio seemed to be a more powerful predictor of tamponade Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Cardiac tamponade as the first presentation of thymoma: A case report during COVID-19 pandemic

2021 ◽  
pp. 201010582110489
Author(s):  
Nirmalatiban Parthiban ◽  
Huzairi Sani
Keyword(s):  
Cardiac Tamponade ◽  
Locally Advanced ◽  
Mass Effect ◽  
Anterior Mediastinal Mass ◽  
Tumour Resection ◽  
Diagnostic Challenge ◽  
Large Pericardial Effusion ◽  
Threatening Condition ◽  
Mediastinal Vessels ◽  
The Right

We report a case of neoplastic cardiac tamponade, a life-threatening condition, as the initial presentation of an anterior mediastinal malignancy. A 69-year-old gentleman with no known history of malignancy presented to the emergency department with shortness of breath, reduced effort tolerance and chronic cough. Clinically, he was not in distress but tachycardic. He was subjected to echocardiography which revealed large pericardial effusion with tamponade effect. Pericardiocentesis drained 1.5 L of haemoserous fluid. CECT thorax, abdomen and pelvis revealed an anterior mediastinal mass with intrathoracic extension complicated with mass effect onto the right atrium and mediastinal vessels. Ultrasound-guided biopsy histopathology examination revealed thymoma. Due to locally advanced disease, tumour resection was not possible, and patient was referred to oncology team for chemoradiotherapy. We report this case study not only due to the rarity of the case but also to highlight its diagnostic challenge due to the COVID-19 pandemic.

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