BRADYCARDIA: COMMON FEATURE IN ACUTE SHOCK RELATED TO HEMOPERICARDIUM AND TAMPONADE FROM PERCUTANEOUS PERFORATION

Abstract

TYPE: Abstract TOPIC: Cardiovascular Disease PURPOSE: Hemopericardium is an uncommon complication of cardiovascular intervention. Typical hemodynamic features of chronic tamponade include elevation in filling pressures, reduction in stroke volume & compensatory tachycardia. Experimental canine models of acute hemorrhagic tamponade however, have demonstrated bradycardia, which persists after vagotomy, sympathectomy & atropine, possibly related to local para-atrial compression & sinoatrial node ischemia. The heart rate response in humans with acute hemorrhagic tamponade is unknown. METHODS: Ninety-five consecutive patients with acute intra-procedural shock due to cardiac perforation (PEA requiring chest compressions (18%) or acute drop in systolic BP to <90 mm Hg with the acute need for intravenous vasopressor therapy) were studied. All had tamponade confirmed by echocardiography & restoration of hemodynamics by rapid pericardiocentesis. RESULTS: Median (IQR) age was 70 (59-77) years. The precipitating procedure was ablation (58%), coronary (11%) or structural (12%) intervention, pacemaker placement/extraction (9%), pulmonary vein stenting (5%) & miscellaneous (7%). Median blood volume drained was 500 (75–3350) ml. The chamber perforated was the RA (15), RV (23), LA (32), LV, coronary artery or ascending aorta (25), or pulmonary vein (5). Nadir blood pressure (in those with pulse) was 68±14/44±20 mm Hg. Tachycardia was rare (Table). Median heart rate was 70 (57-81) bpm with 29 patients with HR <60. Bradycardia was more likely in younger patients & with atrial versus ventricular perforations. CONCLUSIONS: Despite marked hemodynamic instability in patients with acute hemopericardium, tachycardia was uncommon. CLINICAL IMPLICATIONS: Relative bradycardia, in the hemodynamically unstable cardiac patient, should be recognized as a possible marker of procedural perforation and tamponade. DISCLOSURE: Nothing to declare. KEYWORD: hemodynamics and shock