Acute Pericardial Tamponade Research Articles

Cardiooncology in the ICU - Cardiac Urgencies in Cancer Care.

Cardiovascular disease is an increasing risk of morbidity and mortality in cancer patients, related to an growing number of aging survivors with pre-existing cardiovascular disease and the use of traditional and novel cancer therapies with cardiotoxic effects. While many cardiac complications are chronic processes that develop over time, there are many acute processes that may arise in hospitalized patients. It is important for hospitalists and critical care physicians to be familiar with the recognition and management of these conditions in this unique population. This article reviews the presentation and management of common cardiac urgencies in critically ill cancer patients including acute decompensated heart failure, acute coronary syndromes, arrhythmias, hypertensive crises, pulmonary embolism, pericardial tamponade and myocarditis.

Intra-cardiac motion detection catheter for the early identification of acute pericardial tamponade during invasive cardiac procedures.

To develop and test an intra-cardiac catheter fitted with accelerometers to detect acute pericardial effusion prior to the onset of hemodynamic compromise. Early detection of an evolving pericardial effusion is critical in ensuring timely treatment. We hypothesized that the reduction in movement of the lateral heart border present in developing pericardial effusions could be quantified by positioning an accelerometer in a lateral cardiac structure. A "motion detection" catheter was created by implanting a 3-axis accelerometer at the distal tip of a cardiac catheter. The pericardial space of 5 adult sheep was percutaneously accessed, and pericardial tamponade was created by infusion of normal saline. The motion detection catheter was positioned in the coronary sinus. Intracardiac echocardiography was used to confirm successful creation of pericardial effusion and hemodynamic parameters were collected. Statistically significant reduction in acceleration from baseline was detected after infusion of only 40 ml of normal saline (p < 0.05, ANOVA). In comparison, clinically significant change in systolic blood pressure (defined as >10% drop in baseline systolic blood pressure) occurred after infusion of 80 ml of normal saline (107 ± 22 mmHg vs. 90 ± 12 mmHg p = 0.97, ANOVA), and statistically significant change was recorded only after infusion of 200 ml (107 ± 22 mmHg vs. 64 ± 5 mmHg, p < 0.05, ANOVA). An intra-cardiac motion detection catheter is highly sensitive in identifying acute cardiac tamponade prior to clinically and statistically significant changes in systolic blood pressure, allowing for early detection and treatment of this potentially life-threatening complication of all modern percutaneous cardiac interventions.

Percutaneous Left Atrial Appendage Closure Among Patients With Diabetes (Insights from a National Database)

Atrial fibrillation is a major risk factor for stroke. Left atrial appendage closure (LAAC) has emerged as an alternative to anticoagulation for patients with high risk of bleeding. Diabetes mellitus (DM) is associated with adverse events after cardiac procedures. We sought to compare procedural and hospital outcomes in patients who underwent LAAC with and without DM. The Nationwide Inpatient Database was queried for patients with atrial fibrillation who underwent LAAC between January 1, 2016, and December 31, 2019. The primary outcome was all adverse events that included in-hospital death, acute myocardial infarction, cardiac arrest, stroke, pericardial effusion, pericardial tamponade, pericardiocentesis, pericardial window, and postprocedural hemorrhage requiring blood transfusion. Analysis included 62,220 patients who underwent LAAC from 2016 to 2019; 34.9% of patients had DM. There was a slight increase in the percentage of patients who underwent LAAC who had DM during the study period, from 29.92% to 34.93%. In unadjusted and adjusted analysis, there was no significant difference in all adverse events between patients with and without DM who underwent LAAC (9.18% vs 8.77%, respectively, adjusted p=0.63), and no difference in length of stay. Patients with DM have higher risk of acute kidney injury (3.75 vs 1.96%, p<0.001). This nationwide retrospective study demonstrates that DM is not associated with an increase in adverse event rates in patients who underwent LAAC.

Acute Pericardial Tamponade Caused by Ruptured Cardiac Hydatid Cyst

Acute Pericardial Tamponade Caused by Ruptured Cardiac Hydatid Cyst

CT-514 Acute Cardiac Tamponade Following Adult Allogeneic Hematopoietic Transplantation

Large pericardial effusions (LPEs) occur in <1% of the adult population. Early onset (<100 days from allogeneic hematopoietic transplantation (allo-SCT)) LPEs are related to cardiac toxicity of conditioning regimen while late LPEs (>100 from allo-SCT) are chronic GvHD related. The major determinant of acute pericardial tamponade (ACT) is the rapidity with which fluid accumulates. We herein document 4 adult patients with early LPEs that led to ACT. Interestingly, 3 of these also manifested idiopathic immune thrombocytopenia (ITP), an association that has not been previously described. Median age of 3 females and 1 male was 46 years (range 19-58). All patients received high-dose cyclophosphamide either as part of conditioning or post-transplant GvHD prevention (conditioning comprised: busulfan, fludarabine and tiotepa and post-transplantation cyclophosphamide =1, cyclophosphamide, total body irradiation and alemtuzumab =2 and cyclophosphamide and antithymocyte globulin =1). Donors comprised: matched unrelated donor =2, matched sibling donor =1 and haploidentical donor =1. Engraftment occurred on days +20, +30, +12, and +21. All four patients developed ACT at <100 days from allo-SCT on days +1, +16, + 22, and +60 after allo-SCT. ACT manifested as acute, new, or worsening shortness of breath. At ACT, all 4 were negative for CMV infection and acute GvHD (aGVHD). Pericardial fluid was serous in 2 and serosanguinous in 2 patients. Laboratory analysis did not support bacterial or viral infections and rheumatologic profile was negative. ACT was managed by cardiologist who performed either pericardiocentesis with pericardial drain or pericardial window. A cumulative total of 1700 ml, 1500 ml, 1500 ml and 300 ml pericardial fluid was removed. LPEs reoccurred in 2 patients; one with ACT physiology required pericardial window. Additionally, 3 patients developed ITP after development of ACT. The median time to ITP was day+30 (30, 30 and 75 days) from engraftment. Bone marrow biopsies in patients who developed ITP revealed adequate megakaryocytes. ITP responded promptly to steroids, thrombopoietin receptor agonists and IVIG. Prompt cardiac evaluation with doppler echocardiogram facilitates lifesaving management of ACT. Early onset LPEs in our patients was not associated with aGVHD; it is more likely to be associated with cardiac toxicity of cyclophosphamide. Association with ITP may reflect shared pathogenesis.

Direct autotransfusion in the management of acute pericardial tamponade during catheter ablation for atrial fibrillation: An imperfect but practical method.

BackgroundAcute pericardial tamponade (APT) is one of the most serious complications of catheter ablation for atrial fibrillation (AF-CA). Direct autotransfusion (DAT) is a method of reinjecting pericardial blood directly into patients through vein access without a cell-salvage system. Data regarding DAT for APT are rare and provide limited information. Our present study aims to further investigate the safety and feasibility of DAT in the management of APT during the AF-CA procedure.Methods and resultsWe retrospectively reviewed 73 cases of APT in the perioperative period of AF-CA from January 2014 to October 2021 at our institution, among whom 46 were treated with DAT. All included patients successfully received emergency pericardiocentesis through subxiphoid access guided by X-ray. Larger volumes of aspirated pericardial blood (658.4 ± 545.2 vs. 521.2 ± 464.9 ml), higher rates of bridging anticoagulation (67.4 vs. 37.0%), and surgical repair (6 vs. 0) were observed in patients with DAT than without. Moreover, patients with DAT were less likely to complete AF-CA procedures (32/46 vs. 25/27) and had a lower incidence of APT first presented in the ward (delayed presentation) (8/46 vs. 9/27). There was no difference in major adverse events (death/disseminated intravascular coagulation/multiple organ dysfunction syndrome and clinical thrombosis) (0/0/1/0 vs. 1/0/0/0), other potential DAT-related complications (fever/infection and deep venous thrombosis) (8/5/2 vs. 5/3/1), and length of hospital stay (11.4 ± 11.6 vs. 8.3 ± 4.7 d) between two groups.ConclusionDAT could be a feasible and safe method to deal with APT during AF-CA procedure.

Abstract 10817: Association of Hospital Procedural Volumes with Outcomes of Left Ventricular Assist Devices

Introduction: Left Ventricular Assist Devices (LVADs) are effective and feasible options for stage D heart failure. The impact of procedural volumes on LVAD outcomes has been seldomly investigated. Methods: We investigated the Nationwide Readmission Database for the impact of different institutional LVAD volumes on clinical outcomes in 2018. Institutional procedural volumes were stratified into Low (1-7/year), medium (8-24/year) and high (&gt;25/year). Multivariant analysis and adjusted odds ratio was performed to examine association between LVAD hospital volumes and outcomes. Primary outcome was major adverse events (MAE) defined as a composite of mortality, myocardial infarction, stroke or TIA, bleeding requiring transfusion, acute kidney injury, vascular complications and pericardial effusion or tamponade requiring pericardiocentesis or surgery. Results: A total of 2315 patients underwent LVAD placement, with a mean age of 57. No difference in age, sex or presence of chronic disease was noted among patient in different procedural volume tiers. There was statistically significant difference in MAE in medium-volume center when comparing to low volume centers. No difference in MAE was present in low and high-volume center. No significant difference was noted in 30-day all cause readmission, 30-day heart failure readmission or in individual components of MAE across different hospital procedural volumes. Conclusions: Medium-volume centers are associated with better composite clinical outcomes. Overall, no difference in mortality, stroke or myocardial infarction exists among different volume centers. Further clinical research is warranted to clarify the appropriate minimum LVAD procedural volumes required for accreditation.

Acute Pericardial Tamponade Associated with Myopericarditis due COVID-19 in a Pediatric Patient

We report of a 4-year-old asthmatic female presenting with severe respiratory failure and multi-system inflammatory condition in the setting of acute COVID-19 infection. Despite mechanical ventilation and vasoactive support, she showed hemodynamic instability. Cardiomegaly was evident on chest X-ray and significantly depressed left ventricular function with a large pericardial effusion and signs of tamponade were seen on echocardiography. The effusion was successfully drained percutaneously and her clinical condition improved progressively. Our patient got extubated and discharged home, 4 and 8 days after initial presentation, respectively, with an echocardiogram depicting normal left ventricular function and no recurrent pericardial effusion. Acute cardiac tamponade after COVID-19 infection is rare in pediatric patients but can be life threatening. In our patient, high suspicion of myopericarditis and pericardial effusion led to early intervention and fast recovery on a critically ill patient.

A strategy of idarucizumab for pericardial tamponade during perioperative period of atrial fibrillation ablation.

To investigate theoptimal idarucizumab (dabigatran antagonist) usage strategy for patients with acute pericardial tamponade receiving uninterrupted dabigatran during catheter ablation for atrial fibrillation (AF). Ten patients presenting acute pericardial tamponade while receiving uninterrupted dabigatran during catheter ablation for AF in Beijing Anzhen Hospital from January 2019 to July 2020 were enrolled and retrospectively analyzed. A "wait and see" strategy of idarucizumab was carried out for all patients; in brief, idarucizumab was applied following pericardiocentesis, comprehensive evaluation of bleeding and hemostasis. There were five males, five paroxysmal AF, and the average age of the patients was 64.0 ± 9.8 years. Among the 10 patients, four were treated with dabigatran 110mg, six were treated with dabigatran 150mg, and one was simultaneously given clopidogrel. The average time from pericardial tamponade to the last dose of dabigatran was 8.2 ± 3.4 h. All patients underwent pericardiocentesis successfully, and the average drainage volume was 322.5ml (220.0 ± 935.0ml). For reversal anticoagulation, six patients received protamine, and five patients received idarucizumab. Of the five patients who were treated with idarucizumab, four presented exact hemostasis, except for one patient who underwent continuous drainage and finally received surgery repair. The average time to restart anticoagulation was 1.1 ± 0.3 days after the procedure, and no rebleeding, embolism or deaths were observed. The "wait and see" strategy of idarucizumab for acute pericardial tamponade during the perioperative period of catheter ablation for AF may be safe and feasible.

The Art and the Science of Manager Due Diligence

Systemic lupus erythematosus (SLE) is a chronic inflammatory condition with various cardiovascular sequelae. Pericarditis is the most common cardiac manifestation, yet patients also have a markedly elevated risk of premature atherosclerosis and acute coronary syndrome (ACS). This makes the diagnosis of ischaemic chest pain both challenging and crucial in these patients. Here, we examine the case of a 39-year-old male who presented with acute myopericarditis and pericardial tamponade in the setting of newly diagnosed SLE. Several days later, the patient experienced an infero-septal non-ST-elevation myocardial infarction. Urgent percutaneous coronary intervention showed 100% proximal right coronary artery (RCA) occlusion with subsequent placement of two overlapping drug-eluting stents to the proximal-mid RCA. This case illustrates the need to carefully evaluate patients with SLE for underlying cardiovascular disease regardless of age or the presence of tradition risk factors. Recognition of the increased incidence of ACS in SLE patients is crucial for early diagnosis and revascularisation.

Acute pericardial tamponade with multiple pulmonary nodules: is it tuberculosis?

原发性心脏肿瘤极为罕见，我们报告1例以急性心包填塞起病的患者，在接受抗结核治疗后胸痛、呼吸困难等症状消失。2个月后，胸部CT增强扫描显示右心房肿块及肺和胸膜多发结节，经组织活检证实为血管肉瘤。不幸的是，尽管接受了积极的抗血管靶向治疗，但患者最终死于呼吸衰竭。.

Comprehensive Mechanism, Novel Markers and Multidisciplinary Treatment of Severe Acute Pancreatitis-Associated Cardiac Injury - A Narrative Review.

Acute pancreatitis (AP) is one of the common acute abdominal inflammatory diseases in clinic with acute onset and rapid progress. About 20% of the patients will eventually develop into severe acute pancreatitis (SAP) characterized by a large number of inflammatory cells infiltration, gland flocculus flaky necrosis and hemorrhage, finally inducing systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS). Pancreatic enzyme activation, intestinal endotoxemia (IETM), cytokine activation, microcirculation disturbance, autonomic nerve dysfunction and autophagy dysregulation all play an essential role in the occurrence and progression of SAP. Organ dysfunction is the main cause of early death in SAP. Acute kidney injury (AKI) and acute lung injury (ALI) are common, while cardiac injury (CI) is not, but the case fatality risk is high. Many basic studies have observed obvious ultrastructure change of heart in SAP, including myocardial edema, cardiac hypertrophy, myocardial interstitial collagen deposition. Moreover, in clinical practice, patients with SAP often presented various abnormal electrocardiogram (ECG) and cardiac function. Cases complicated with acute myocardial infarction and pericardial tamponade have also been reported and even result in stress cardiomyopathy. Due to the molecular mechanisms underlying SAP-associated cardiac injury (SACI) remain poorly understood, and there is no complete, unified treatment and sovereign remedy at present, this article reviews reports referring to the pathogenesis, potential markers and treatment methods of SACI in recent years, in order to improve the understanding of cardiac injury in severe pancreatitis.

Clinical characteristics and treatment effects of astragalus injection in non-pediatric patients with acute fulminant myocarditis.

To explore the clinical characteristics of non-pediatric patients with acute fulminant myocarditis (AFM) and evaluate the treatment effects of astragalus injection on this disease.A total of 54 AFM patients were screened out from 586 patients with acute myocarditis, admitted to the department of cardiology between January 2011 to June 2018. The demographic and clinical data, investigations, treatments, and short-term outcomes were collected and retrospectively analyzed.The mean age of the 54 AFM patients was 34 ± 16.5 years old (range: 13–70 years), including 24 (44.5%) men and 30 (55.5%) women, with a high incidence in 2 age groups: 13–19 and 40–49 years old, despite an inverse trend to the increase of age. All these cases were admitted in emergency conditions: 26 (48.1%) cardiogenic shock, 18 (33.4%) malignant arrhythmias, 8 (14.8%) severe heart failure, and 2 (3.7%) acute pericardial tamponade. Apart from first-aid measures, 37 (68.5%) patients received astragalus injection. During hospitalization, 11 (20.4%) patients died, and 4 (36.3%) of them were from astragalus group while 7 (63.7%) of them from without-astragalus group (P=0.03). Furthermore, the levels of cardiac injury biomarkers, renal function and left ventricular ejection fraction of astragalus group were significantly improved compared with those of without-astragalus group at discharge (all P < .05).Middle-aged people were also prone to AFM. And cardiac shock was the most common, while acute pericardial tamponade was a rare presentation in non-pediatric AFM patients. Astragalus was a potential adjuvant medicine for the treatment of AFM.

A case of acute pericardial tamponade caused by spontaneous left atrial rupture was successfully rescued

A case of acute pericardial tamponade caused by spontaneous left atrial rupture was successfully rescued

Dolor torácico

One of the most common causes of emergency department visits is thoracic pain. Differentiation between benign and severe conditions is the key point. Early goal is double. On the one hand, etiological diagnosis has to be pointed and, by the other, proper risk patient rating has to be performed in order to establish the most appropriate treatment. Electrocardiogram has to be performed in less than first 10minutes after medical assistance. Complementary tests have to be performed after anamnesis and complete physical examination had to be carried out. According with diagnosis and condition severity, patient could be either admitted in intensive care unit (when monitoring is necessary), or discharged (home treatment). Taking into account the prevalence and severity, acute coronary syndrome is the most important condition coursing with thoracic pain; so, it has to be suspected in cases where the initial diagnosis is not clear. Other etiologies requiring intensive management are: acute aortic syndrome, pulmonary embolism, pericardial tamponade, tension pneumothorax and esophageal perforation.

Risk factors for postoperative hyperlactatemia in patients with type A aortic dissection

Objective To identify the risk factors for postoperative hyperlactatemia in the patients with type A aortic dissection. Methods Medical records of patients with type A aortic dissection who underwent cardiovascular surgery from January 2012 to October 2017 were retrospectively collected.The patients were divided into hyperlactatemia group and non-hyperlactatemia group according to the occurrence of hyperlactatemia (blood lactic acid ≥6 mmol/L) at 8 h after surgery.The variables of which P values were less than 0.05 in univariate analysis would enter the logistic regression analysis to stratify the risk factors for postoperative hyperlactatemia in this type of patients. Results A total of 295 patients were included, of which 80 cases developed postoperative hyperlactatemia, and the incidence was 27.1%.Logistic regression analysis showed that preoperative acute pericardial tamponade, intraoperative deep hypothermic circulatory arrest time>35 min) and massive transfusion of blood (>1 000 ml) within 8 h after operation were independent risk factors for postoperative hyperlactatemia in the patients with type A aortic dissection. Conclusion Preoperative acute pericardial tamponade, intraoperative deep hypothermic circulatory arrest time>35 min and massive transfusion of blood (>1 000 ml) within 8 h after operation are independent risk factors for postoperative hyperlactatemia in the patients with type A aortic dissection. Key words: Aneurysms, dissection; Hyperlactatemia; Risk factor

LUNG CANCER WITH CARDIAC COMPLICATIONS

Malignant pericardial disease in the setting of lung cancer portends a grave prognosis. We present a case of malignant pericardial tamponade and subsequent complications. A 61-year-old man presented with acute pericardial tamponade after having undergone a video-assisted left upper lobe

Cardiac Complications in the Adult Bone Marrow Transplant Patient.

Due to advancements in oncologic treatment strategies and techniques, the number of survivors who have undergone hematopoetic stem cell transplant (HCT) continues to increase in the United States; this number is projected to reach 502,000 by the year 2030. There is significant interest within the field of cardio-oncology to identify cardiotoxicity and cardiovascular disease in the HCT population. Epidemiologic studies analyzing both short- and long-term cardiovascular effects, risk stratification modeling, cardioprotective strategies, and expert consensus documents for cardiotoxicity surveillance recommendations are reviewed. Patients who have undergone HCT are at increased risk of cardiovascular events and mortality compared to matched controls. The type of cardiotoxicity and the incidence rates vary based on specific therapeutic regimens and pre-existing cardiovascular risk factors. Life-threatening cardiotoxicity can present during HCT as acute heart failure, arrhythmias, pericardial tamponade, or cardiac arrest; or it can present late after treatment as cardiomyopathy, ischemic heart disease, vascular disease, stroke, or comorbid conditions, such as hypertension and diabetes mellitus that are associated with cardiac events. HCT is associated with excess cardiovascular risk partially due to exposure to cardiotoxic chemotherapy and radiation, as well as indirect and direct detrimental effects on cardiovascular reserve. This review discusses the epidemiology and the known cardiotoxic effects of historical chemoradiation agents in addition to newer targeted therapies. Recent expert consensus statements from cardiology and hematology/oncology societies are reviewed in regard to risk stratification of the cancer patient based on the type of treatments. Finally, gaps in knowledge are identified with proposed avenues of research that will allow for more accurate risk assessment, prediction, and potential treatment of the HCT patient in attenuating the risk of developing both short- and long-term cardiovascular comorbidities.

Acute Traumatic Pericardial Tamponade.

Acute traumatic pericardial tamponade is a serious and rapidly fatal injury. As penetrating chest wounds are becoming more cammon, early diagnosis of tamponade is important so that life savingtreatement can be started. The classical features of tamponade may a be modified by hypovolemia and the presence of associated injuries. Acute tamponade may also be precipitated by rapid administration of large volumes of fluid. Echocardiography is limited by availability and operator dependence. Pericardiocentesis, while sometimes life saving is dangereous and limited value. A higher deagree of clinical suspincion in patients with chest injuries, together with close monitoring and revaluation, particulary during volume remplancement is essential. This paper describes one patient presented to the emergency department of University Hospital Center “Mother Theresa “ and it discusses the epidemiology and management principles of acute tamponade.

Pathophysiology, clinical and experimental possibilities of pericardial tamponade

Acute pericardial tamponade is one of the most emergent clinical scenarios in cardiac surgery. With numerous causes in the background, pericardial tamponade can lead to cardiogenic shock and death. In modern diagnostic era, the recognition of pericardial tamponade is simple, but its management and the long-term effects can still be challenging. Without the detailed understanding of the pathophysiological pathways diagnostic and therapeutic management plans of pericardial tamponade is very difficult. The aim of this review was to give a complex picture of pericardial tamponade, from its role in medical history to pathophysiology and its significance in surgical experimental models. Orv Hetil. 2018; 159(5): 163-167.