Management Of Cardiac Tamponade Research Articles

Cardiac Arrest Following Retrieval of Inferior Vena Cava Filter: A Case Report and Literature Review of Pericardial Effusion and Cardiac Tamponade.

Understanding the link between pericardial effusion and cardiac tamponade following IVC filter removal.Recognising and differentiating cardiac tamponade from other emergencies using clinical and diagnostic tools.Learning the immediate management of cardiac tamponade, emphasising the role of pericardiocentesis.

The infrastructure of electrophysiology centers impacts the management of cardiac tamponade-Results from a national survey.

Although electrophysiological (EP) centers have institutional standards, evidence on management of cardiac tamponade is lacking. A physician-based survey was conducted by sending out questionnaires to all hospitals in Germany performing EP procedures. To evaluate the infrastructure of EP centers and the impact of center volume and onsite cardiac surgery on the management of cardiac tamponade, the results of the survey were analyzed for low-volume (0-250 procedures per year), mid-volume (250-500 procedures), and high-volume (>500 procedures) centers, as well as for centers with and without onsite cardiac surgery. A total of 341 centers were identified and 189/341 (55%) returned data sets were analyzed. Most types of EP procedures are performed across all kinds of centers. Ablation of ventricular tachycardia (VT) is concentrated in higher volume centers and in centers with onsite cardiac surgery. None of the participating low-volume centers and only 13% of centers without onsite cardiac surgery responded to performing epicardial VT ablation. Irrespective of center volume and onsite cardiac surgery, neither body mass index nor age was reported to be an exclusion criterion for ablation procedures. Higher volume centers and centers with onsite cardiac surgery more often have dedicated EP laboratories and EP-nursing teams. Also, differences regarding periprocedural safety precautions and management of cardiac tamponade were found for low-, mid-, and high-volume centers, as well as for centers with and without onsite cardiac surgery. While center volume and onsite cardiac surgery do not impact patient selection, there are differences in ablation spectrum, infrastructure, periprocedural safety precautions, and treatment of tamponade.

Iatrogenic Cardiac Tamponade Secondary to Central Venous Catheter Placement: A Literature Review.

Cardiac tamponade is the fluid accumulation within the pericardial sac that compresses the heart and decreases cardiac output. More than 20% of the cases are surgical or non-surgical iatrogenic causes. Cardiac tamponade has been described as a rare complication of central venous catheter placement with an incidence in adults as low as less than 1% but with significantly high mortality of more than 60%. The purpose of this article is to review the incidence, clinical manifestations, pathophysiology, diagnosis, and management of cardiac tamponade after central venous catheter placement as well as different methods to prevent this fatal complication from occurring.

Management of pericardial tamponade in the electrophysiology laboratory: results from a national survey

BackgroundDespite continued efforts to improve the safety of catheter ablation, pericardial tamponade remains one of its more frequent, potentially life-threatening complications. Management of cardiac tamponade is not standardized and uncertainties regarding acute treatment remain.MethodsThis survey sought to evaluate the management of cardiac tamponade in German EP centers via a standardized postal questionnaire. All 341 identified German EP centers were invited to return a questionnaire on their standards for the management of cardiac tamponade.ResultsA total of 189 German EP centers completed the questionnaire. Several precautions are followed to avoid pericardial tamponade: A minority of centers preclude very old patients (19%) or those with a high body mass index (30%) from ablation. Non-vitamin K antagonist oral anticoagulants are briefly paused in most centers (88%) before procedures, while vitamin K antagonists are continued. Pericardial tamponade is usually treated using reversal of heparin by applying protamine (86%) and pericardiocentesis under both, fluoroscopic and echocardiographic guidance (62%). A pigtail catheter is mostly inserted (97%) and autotransfusion of aspirated blood is performed in 47% of centers. The decision for surgical repair depends on different clinical and infrastructural aspects. The timing of reinitiation of anticoagulation widely differs between the centers. Approximately 1/3 of centers prescribe nonsteroidal anti-inflammatory agents, colchicine or steroids after pericardiocentesis.ConclusionThe present survey shows that the management of cardiac tamponade is still inhomogeneous in German ablation centers. However, multiple findings of this survey can be generalized and might guide especially less experienced operators and centers in their treatment and decision strategies.

CARDIAC TAMPONADE WITHOUT CHARACTERISTIC ECHOCARDIOGRAPHIC FEATURES DUE TO HIGH RIGHT HEART PRESSURE FROM PULMONARY HYPERTENSION

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Introduction: Cardiac tamponade occurs when pericardial effusion leads to equalization of intrapericardial pressure and diastolic intracardiac pressure, which reduces the systemic venous-to-right atrial pressure gradient, leading to depression in cardiac output. The lower this gradient, the greater the risk for cardiac tamponade. Cardiac tamponade manifests clinically as shock, jugular venous distention, and muffled heart sounds, known collectively as Beck's triad. Typical findings on echocardiogram are right atrial and ventricular collapse.[2] These findings may not be seen in patients with elevated right-sided intracardiac pressure and can lead to misdiagnosis or delay in diagnosis of cardiac tamponade.[1] We present a patient with a cardiac tamponade to highlight this point. CASE PRESENTATION: Case presentation: A 46 year old male with hypoxia and respiratory failure from COVID-19 pneumonia supported with mechanical ventilation for several weeks developed refractory shock of multifactorial etiology. The patient was known to have pulmonary hypertension with dilated right atrial and ventricular pressure in addition to paradoxical septal motion, as seen on echocardiogram of recent past. Clinical examination revealed jugular venous distention and muffled heart sounds. Electrocardiogram detected sinus tachycardia and low cardiac voltage. Echocardiogram revealed large pericardial effusion without right atrial or ventricular collapse, and therefore cardiac tamponade was not considered as the cause of shock. As shock remained refractory to multiple vasopressors and inspiratory variation of the mitral valve inflow was noted on echocardiogram, it was decided to initiate pericardial drainage. However, the patient went into cardiac arrest before it could be performed. DISCUSSION: Discussion: A clinical diagnosis of cardiac tamponade can be made in the presence of Beck's triad. However, echocardiogram is most often relied on to make the diagnosis. The most sensitive echocardiographic findings of cardiac tamponade are right atrial and ventricular collapse.[2] Though sensitive, these changes may not be present in a patient who has preexisting elevated right sided intracardiac pressure. In such cases, the diagnosis must be based on clinical evidence and can be aided by the findings of exaggerated changes in mitral/tricuspid inflow during respiration. CONCLUSIONS: Conclusion: A hallmark finding of cardiac tamponade is right atrial or ventricular collapse on echocardiogram. However, these findings may be absent in the setting of elevated right-sided intracardiac pressure. The absence of right atrial or ventricular collapse in our patient can be attributed to the elevated right-sided intracardiac pressure due to pulmonary hypertension.[3] In such cases, the diagnosis of cardiac tamponade should be made on clinical grounds and pericardial drainage should not be delayed. REFERENCE #1: 1. Adams JR, Tonelli AR, Rokadia HK, Duggal A. Cardiac tamponade in severe pulmonary hypertension. A therapeutic challenge revisited. Ann Am Thorac Soc. 2015;12(3):455-460. REFERENCE #2: 2. Spodick DH. Acute cardiac tamponade. N Engl J Med. 2003;349(7):684-690. REFERENCE #3: 3. Vallabhajosyula, S., Kanuri, S., Sundaragiri, P., & Alla, V. (2014). Management of cardiac tamponade in severe pulmonary hypertension. Chest, 146(4). DISCLOSURES: No relevant relationships by George Apergis, source=Web Response No relevant relationships by Dushyant Damania, source=Web Response No relevant relationships by Aaron Douen, source=Web Response No relevant relationships by Padmanabhan Krishnan, source=Web Response No relevant relationships by George Mbolu, source=Web Response No relevant relationships by Ryan Panetti, source=Web Response

Cardiac Tamponade.

This simulation is designed to educate emergency medicine residents and medical students on the recognition and management of cardiac tamponade, as well as encourage providers to become familiar with their states' disclosure laws for sentinel events. Cardiac tamponade is an emergent condition in which the accumulation of pericardial fluid and the consequent increase in hydrostatic pressure becomes severe enough to compromise the normal diastolic and systolic function of the heart, resulting in hemodynamic instability.1 The causes of cardiac tamponade are numerous because it is a potential complication of any of a number of pericardial disease processes, including infectious, inflammatory, traumatic, and malignant etiologies.1,2 Clinical presentations may vary and symptoms can be non-specific, which can lead to delayed or missed diagnoses and poor patient outcomes.3 In addition to this, the incidence of this condition is rising due to the increasing frequency of cardiac procedures performed (ie, pacemaker placement).4 Therefore, it is important for medical providers to have a high index of suspicion for the diagnosis based on patient presentation and to quickly provide necessary treatment to stabilize the patient. By the end of this simulation session, the learner will be able to: (1) describe a diagnostic differential for dizziness (2) describe the pathophysiology of cardiac tamponade (3) describe the acute management of cardiac tamponade, including fluid bolus and pericardiocentesis (4) describe the electrocardiogram (ECG) findings of pericardial effusion (5) describe the ultrasound findings of cardiac tamponade (6) describe the indications for emergent bedside pericardiocentesis versus medical stabilization and delayed pericardiocentesis for cardiac tamponade (7) describe the procedural steps for pericardiocentesis, and (8) describe your state's laws regarding disclosure for sentinel events. This session is conducted using high-fidelity simulation, followed by a debriefing session on evaluation and treatment of cardiac tamponade. However, it may also be run as an oral board case. Our residents were provided an electronic survey at the completion of the debriefing session so they may rate different aspects of the simulation, as well as provide qualitative feedback on the scenario. This survey is specific to the local institution's simulation center. Feedback was largely positive because many learners mentioned during debriefing that they are not comfortable with pericardiocentesis and have limited opportunities to practice the procedure. None of our residents were familiar with our state's or institution's disclosure laws for sentinel events.The local institution's simulation center feedback form is based on the Center of Medical Simulation's Debriefing Assessment for Simulation in Healthcare (DASH) Student Version Short Form with the inclusion of required qualitative feedback if an element was scored less than a 6 or 7.5 This session received a majority of 6 (consistently effective/very good) and 7 scores (extremely effective/outstanding). This is a potential method for educating future medical providers on the diagnosis and management of cardiac tamponade in an emergency department setting. Learners initially had a wide range of differentials for the chief complaint of dizziness. We used an ECG with low voltage but without electrical alternans. When asked to provide an ECG interpretation, low voltage was intermittently explicitly interpreted by learners. We were concerned that if we showed an ECG with electrical alternans, learners may quickly arrive at the diagnosis without focusing on the subtleties of a physical exam, including looking for jugular venous distention (JVD) or pulsus paradoxus.We did not have the patient decompensate if their international normalized ratio (INR) was not immediately reversed, given likely delay for in vivo coagulation to occur in the face of life-threatening tamponade, but this provided a robust discussion during debriefing if reversal should be emergently initiated.Many residents voiced that they were uncomfortable performing a pericardiocentesis because they only had a few opportunities to do so on human cadavers, and they appreciated the opportunity to review this.Unexpectedly, when the patient asked the learners if he should sue the cardiologist, the majority of groups told the patient that the cardiologist was not liable because tamponade is a known complication of cardiac ablation and likely reviewed this while obtaining informed consent. None of the learners were familiar with Ohio's disclosure laws for sentinel events. This identified a gap in knowledge that may be addressed in future learning sessions.Our main take-away is to continue providing low-frequency, high-acuity cases that provide the opportunity to review infrequent pathologies and procedures, as well as including patient safety and administrative learning points. Medical simulation, cardiac tamponade, pericardial effusion, cardiac emergencies, obstructive shock, sentinel events, iatrogenic injury, medical disclosure.

Pediatric Emergency Medicine Simulation Curriculum: Cardiac Tamponade.

Cardiac tamponade is an uncommon presentation to the pediatric emergency department and requires early recognition and emergent intervention. We developed this patient simulation case to simulate a low-frequency, high-acuity scenario for pediatric emergency medicine fellows and resident physicians in emergency medicine, pediatrics, and family medicine. We ran the case in a pediatric emergency department using a high-fidelity pediatric mannequin and equipment found in the clinical environment, including a bedside ultrasound machine. The case involved a 10-year-old patient with Hodgkin lymphoma who presented with fever, neutropenia, and shock and was found to have a pericardial effusion with tamponade after evaluation. The providers were expected to identify signs and symptoms of shock, as well as cardiac tamponade, and demonstrate appropriate emergent evaluation and management. Required personnel included a simulation technician, instructors, and a nurse. Debriefing tools tailored specifically for this scenario were created to facilitate a formal debriefing and formative learner assessment at the end of the simulation. This case has been implemented with 10 pediatric emergency medicine fellows during two 3-year cycles of fellow education. Session feedback reflected a high level of satisfaction with the case and an increased awareness of bedside ultrasound in the identification of cardiac tamponade. This resource for teaching the critical components for diagnosing and managing unstable cardiac tamponade in the pediatric patient, including use of bedside ultrasound, was well received by pediatric emergency medicine fellows.

21) Innovative Sternotomy Simulation Model for Training Pediatric Cardiac Intensive Care Team

Purpose: Simulation has been identified as an important training method for improving patient safety and quality of care. We designed a hi-fidelity mannequin mimicking the human thorax with a median sternotomy and a heart model to reproduce cardiac tamponade. We sought to evaluate - 1) the face validity of the innovative sternotomy mannequin for cardiac tamponade scenario and 2) multi-disciplinary team training in management of cardiac tamponade in children with a sternotomy wound. Method: We conducted a prospective observational study using the mannequin with a median sternotomy, an artificial heart inside thorax and the capability of reproducing cardiac tamponade (Fig.1). The study participants were the team members …

Diagnosis and emergency management of cardiac tamponade

Diagnosis and emergency management of cardiac tamponade

Mortality and Cerebrovascular Events After Heart Rhythm Disorder Management Procedures.

Recognition of rates and causes of hard, patient-centered outcomes of death and cerebrovascular events (CVEs) after heart rhythm disorder management (HRDM) procedures is an essential step for the development of quality improvement programs in electrophysiology laboratories. Our primary aim was to assess and characterize death and CVEs (stroke or transient ischemic attack) after HRDM procedures over a 17-year period. We performed a retrospective cohort study of all patients undergoing HRDM procedures between January 2000 and November 2016 at the Mayo Clinic. Patients from all 3 tertiary academic centers (Rochester, Phoenix, and Jacksonville) were included in the study. All in-hospital deaths and CVEs after HRDM procedures were identified and were further characterized as directly or indirectly related to the HRDM procedure. Subgroup analysis of death and CVE rates was performed for ablation, device implantation, electrophysiology study, lead extraction, and defibrillation threshold testing procedures. A total of 48 913 patients (age, 65.7±6.6 years; 64% male) who underwent a total of 62 065 HRDM procedures were included in the study. The overall mortality and CVE rates in the cohort were 0.36% (95% confidence interval [CI], 0.31-0.42) and 0.12% (95% CI, 0.09-0.16), respectively. Patients undergoing lead extraction had the highest overall mortality rate at 1.9% (95% CI, 1.34-2.61) and CVE rate at 0.62% (95% CI, 0.32-1.07). Among patients undergoing HRDM procedures, 48% of deaths directly related to the HDRM procedure were among patients undergoing device implantation procedures. Overall, cardiac tamponade was the most frequent direct cause of death (40%), and infection was the most common indirect cause of death (29%). The overall 30-day mortality rate was 0.76%, with the highest being in lead extraction procedures (3.08%), followed by device implantation procedures (0.94%). Half of the deaths directly related to an HRDM procedure were among the patients undergoing device implantation procedures, with cardiac tamponade being the most common cause of death. This highlights the importance of the development of protocols for the quick identification and management of cardiac tamponade even in procedures typically believed to be lower risk such as device implantation.

Diagnosis and Acute Management of Cardiac Tamponade

Cardiac tamponade is a medical and surgical emergency that requires quick recognition and treatment by the critical care provider. Tamponade results from accumulation of fluid in the pericardial space leading to equalization of pressures between the pericardial space, atria, and ventricles. This alteration in physiology causes hemodynamic changes that can range from tachycardia and hypotension to cardiovascular collapse. Diagnosis relies on a high index of suspicion and accurate interpretation and use of multiple diagnostic modalities. One of the most important tools, echocardiography, plays a vital role in the diagnosis, monitoring, and treatment of tamponade. Treatment depends on the hemodynamic stability of the patient and may include advanced cardiac life support, emergent pericardiocentesis, emergent sternotomy, or medical management. This review discusses the acute diagnosis and management of cardiac tamponade specifically related to surgical patients cared for by the critical care provider. This review contains 2 figures, 2 tables, 5 videos, and 55 references. Key words: atrial and ventricular collapse, cardiac tamponade, cardiogenic shock, critical care echocardiography, equalization of pressures, hemopericardium, pericardial effusion, pericardiocentesis, pulsus paradoxus, ventricular interdependence

Utility of bedside cardiac ultrasound in the management of cardiac tamponade

En los ultimos anos, tanto en diferentes estudios como en la practica clinica habitual, ha quedado demostrada la utilidad de la ecografia a pie de cama para optimizar el manejo de los pacientes criticos, debiendo ser hoy en diauna herramienta mas que nos guie en el manejo de este tipo de pacientes. En este articulo se presenta la utilidad de la ecografia a pie de cama en la deteccion y manejo de una paciente con signos iniciales de taponamiento cardiaco,antes de que presente hipotension severa, lo que permitio tomar una decision pronta para su manejo y condiciono posteriormente su recuperacion.

手術によりQOLが改善した乳癌の心膜・小腸転移の1例

手術によりQOLが改善した乳癌の心膜・小腸転移の1例

Perikarderguss

Cardiac tamponade can be a life-threatening condition due to the high variability of clinical symptoms and the associated risk of rapid hemodynamic deterioration. Therefore, accurate diagnosis followed by immediate intervention is necessary. Common clinical features of cardiac tamponade are pulsus paradoxus, tachycardia, elevated jugular venous pressure and hypotension; however, although these can be indicative of cardiac tamponade they are non-specific. Instant confirmation of the clinical diagnosis of cardiac tamponade can be pursued with echocardiography which also enables a clear estimation of the current hemodynamic situation. Thus in contemporary clinical practice echocardiography plays a key role in the management of cardiac tamponade and must be consulted with regards to final treatment decisions. Common practice includes pericardial puncture under echocardiographic and/or X-ray guidance but only in cases of significantly sized pericardial effusions. Whenever there is a limited sized but hemodynamically significant effusion, inferior pericardiotomy should be the preferred treatment strategy. In cases of cardiac tamponade following chest trauma a full median sternotomy can be a suitable approach for surgical treatment.

Cardiac Tamponade as an Unusual Manifestation of Primary Heart Tumor

Management of cardiac tamponade should be directed toward urgent pericardiocentesis, but it is unsuitable to perform soft tissue compression. When urgent tamponade is diagnosed, intravenous hydration should be instituted, especially if patients had mistakenly received diuretic because of an incorrect diagnosis of congestive heart failure in our case.

Management of Cardiac Tamponade: A Comperative Study between Echo-Guided Pericardiocentesis and Surgery—A Report of 100 Patients

Background. Cardiac tamponade (CT) represents a life-threatening condition, and the optimal method of draining accumulated pericardial fluid remains controversial. We have reviewed 100 patients with CT at our institution over a five-year period and compared the results of echo-guided pericardiocentesis, primary surgical treatment, and surgical treatment following pericardiocentesis with regard to functional outcomes. Methods. The study group consisted of 100 patients with CT attending Yuzuncu Yil University from January 2005 to January 2010 who underwent one of the 3 treatment options (echo-guided pericardiocentesis, primary surgical treatment, and surgical treatment following pericardiocentesis). CT was defined by clinical and echocardiographic criteria. Data on medical history, characteristics of the pericardial fluid, treatment strategy, and follow-up data were collected. Results. Echo-guided pericardiocentesis was performed in 38 (38%) patients (Group A), primary surgical treatment was preformed in 36 (36%) patients (Group B), and surgical treatment following pericardiocentesis was performed in 26 (26%) patients (Group C). Idiopathic and malignant diseases were primary cause of tamponade (28% and 28%, resp.), followed by tuberculosis (14%). Total complication rates, 30-day mortality, and total mortality rates were highest in Group C. Recurrence of tamponade before 90 days was highest in Group A. Conclusions. According to our results, minimal invasive procedure echo-guided pericardiocentesis should be the first choice because of lower complication and mortality rates especially in idiopathic cases and in patients with hemodynamic instability. Surgical approach might be performed for traumatic cases, purulent, recurrent, or malign effusions with higher complication and mortality rates.

Outside the Box: Extra-Pericardial Tamponade Due to Acute Recurrence of Hiatus Hernia

Cardiac tamponade is defined as a life-threatening, slow or rapid compression of the heart due to the pericardial accumulation of fluid, pus, thrombus or gas as a result of effusion, trauma, or myocardial rupture. We describe the case of a lady who developed classic signs of cardiac tamponade immediately after an open hiatus hernia repair. Computed tomographic imaging revealed extrapericardial hernia recurrence causing cardiac compression. We believe this is the first such reported case. We conclude that cardiac tamponade from acute recurrence of hiatus hernia must be considered in the unstable postoperative patient and that the definition of cardiac tamponade is expanded to include extrapericardial pathologies.

Cardiac Tamponade as Complication of Active‐Fixation Atrial Lead Perforations: Proposed Mechanism and Management Algorithm

Cardiac tamponade is a rare complication after implantation of dual chamber pacemaker or defibrillator systems. Its pathophysiology and optimal management are not currently well established. Three cases of cardiac tamponade following successful implantation of transvenous dual chamber pacemakers with active-fixation atrial leads were identified. All three patients with post-implant cardiac tamponade were suspected to have the same etiology of bleeding into the pericardial space. This was due to protrusion of the helix of the active-fixation atrial pacing lead through the atrial wall with subsequent abrasion of visceral pericardial layer and bleeding from the atrium through the perforation. In two patients, the perforation sites were visualized and repaired during open thoracotomy in the operating room. The third patient underwent lead repositioning under fluoroscopic guidance in the electrophysiology laboratory. Based on the reviewed cases, we describe the pathophysiology of, and recommend a safe conservative algorithm for, the management of cardiac tamponade after successful transvenous lead implantation. Percutaneous pericardiocentesis with placement of the pericardial drain followed by lead repositioning under fluoroscopic guidance with surgical backup appears to be safe and effective.

Anesthetic management of cardiac tamponade after dual-chamber implantable cardioverter defibrillator implantation in a patient with dilated cardiomyopathy

We report a case of cardiac tamponade in a patient with dilated cardiomyopathy after undergoing dual-chamber implantable cardioverter-defibrillator (ICD) implantation. General anesthesia was required for subxiphoid pericardiotomy. Although the occurrence rate of adverse events with ICDs has been reported to be high, the acute onset of significant cardiac tamponade is uncommon as a short-term complication of ICD implantation. We describe our anesthetic management of cardiac tamponade in the ICD patient with dilated cardiomyopathy.

Cardiac Tamponade: Pathophysiology, Diagnosis, and Management

Cardiac tamponade is a clinical syndrome that results from an increased intrapericardial pressure and leads to impaired cardiocirculatory function. The spectrum of cardiac tamponade is relatively wide, ranging from an asymptomatic elevation of intrapericardial pressure recognized during objective evaluation, to extreme hemodynamic compromise in the form of severe hypotension or electromechanical dissociation, and many variations between these extremes. This article discusses the causes, pathophysiology, clinical manifestations, diagnosis, and management of cardiac tamponade.