Dying from cardiac tamponade

Swaminathan, A.; Kandaswamy, Karikalan; Powari, Manish; Mathew, Joseph

doi:10.1186/1749-7922-2-22

Cited by 19 publications

(12 citation statements)

References 11 publications

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“…Spontaneous hemopericardium unrelated to trauma is known to occur in 2.5–11% of patients receiving any anticoagulation . Rapidly evolving hemopericardium (200–300 ml) can cause death from cardiac tamponade compared with large but slow accumulation (500–2000 ml), as increased intrapericardial pressure decreases diastolic filling with subsequent hypotension …”

Section: Discussionmentioning

confidence: 99%

“…3 Rapidly evolving hemopericardium (200-300 ml) can cause death from cardiac tamponade compared with large but slow accumulation (500-2000 ml), as increased intrapericardial pressure PHARMACOTHERAPY Volume 34, Number 9, 2014 decreases diastolic filling with subsequent hypotension. 4,5 Rivaroxaban is an orally bioavailable FXa inhibitor. 2 Activation of FX to FXa through the intrinsic and extrinsic clotting pathways plays a central role in the cascade of coagulation.…”

Section: Discussionmentioning

confidence: 99%

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Isolated Hemopericardium Associated With Rivaroxaban: First Case Report

2014

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Rivaroxaban is a novel anticoagulant approved for use in patients with atrial fibrillation for stroke prevention. It is a factor Xa inhibitor, and its activity cannot be monitored with use of the international normalized ratio. A 5.6% chance of major bleeding is associated with rivaroxaban use, including intracranial and gastrointestinal bleeds. We report the first case, to our knowledge, of isolated hemopericardium related to rivaroxaban use, which could potentially lead to death from cardiac tamponade. A 76-year-old man who was receiving rivaroxaban for atrial fibrillation presented to the emergency department with pleuritic chest pain and was found to have a hemopericardium. No signs of tamponade were evident, and his bleed remained stable after discontinuing rivaroxaban. The patient had also been taking saw palmetto, which may have contributed to the bleed by increasing rivaroxaban activity. A work-up for other causes of hemopericardium, including pacemaker lead misplacement and autoimmune disease-related pericarditis, was negative. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 5) between the patient's development of hemopericardium and rivaroxaban use. This case highlights the potential for bleeding complications associated with novel anticoagulants. Herbal products and various drugs may increase rivaroxaban levels by inhibiting P-glycoprotein and cytochrome P450 3A4 activity. Clinicians should be aware of these potential interactions with rivaroxaban and perform a review of not only the patient's drug therapy but also any herbal and food products that could alter the levels of anticoagulants. The lack of an antidote and the inability to dialyze rivaroxaban is a significant concern in situations of life-threatening bleeds. A laboratory test for monitoring rivaroxaban levels may be required for its safe use.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Isolated Hemopericardium Associated With Rivaroxaban: First Case Report

2014

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“…While in the 1960s its most common aetiology was dissecting aortic or syphilitic aneurysms, in a series published by Atar et al 14 in 1999, iatrogenic trauma, malignancy and myocardial infarction were found to be the foremost aetiologies. In another series published by Swaminathan et al 15 in 2007, myocardial infarction and dissecting aortic aneurysm were the top causes. Others have also identified blunt chest trauma as an aetiology 16…”

Section: Discussionmentioning

confidence: 99%

Bleeding heart: a case of spontaneous hemopericardium and tamponade in a hyperthyroid patient on warfarin

et al. 2016

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We describe the case of an 81-year-old female, diagnosed with hyperthyroidism-related atrial fibrillation. Given her CHA2DS2VASc score of 3, she was started on warfarin for stroke prevention. One month later, she was admitted with cardiac tamponade. This tamponade was suspected to be secondary to hemopericardium, based on the elevated international normalized ratio (INR), drop in haemoglobin and the radiodensity (55 HU) of the pericardial effusion on CT. The patient was a Jehovah's witness who therefore initially refused measures for reversing coagulopathy. Given her coagulopathy and absence of imminent haemodynamic compromise, pericardiocentesis was deferred. Unfortunately, 1 day later, the patient deteriorated rapidly. By the time pericardiocentesis was performed and factor VIIa administered, the patient had already started developing multiple organ failure. She developed cardiac arrest and died 3 days after her admission. Only 10 cases of hemopericardium attributable to warfarin have previously been reported. In this report, we review the literature and also describe how hyperthyroidism most likely predisposed our patient to bleeding complications from warfarin.

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“…However, the possibility of myocardium invasion via hematogenous dissemination also may occur. 6,8 The etiology of myocardial rupture is most commonly a result of myocardial infarction, 9 with much less common causes being cardiac trauma, endocarditis, primary and secondary cardiac tumors, infiltrative diseases of the heart, and aortic dissection. [10][11][12] The presentation of cardiac tumors is variable.…”

Section: Discussionmentioning

confidence: 99%