Simultaneous malignant hypertension and cardiac tamponade

Krantz, Mori J.; Woods, Jan E.; Havranek, Edward P.; Linas, Stuart L.

doi:10.1053/ajkd.2002.31428

Cited by 5 publications

(2 citation statements)

References 14 publications

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“…In such cases the patient is unable to fully compensate for the sudden impairment to diastolic filling and blood pressure falls. In contrast, in the absence of trauma tamponade often develops more gradually, and blood pressure is frequently preserved [9]. In addition the presence of tachycardia, pulsus paradoxus and right heart collapse observed on echocardiography corroborated the diagnosis.…”

Section: Discussionmentioning

confidence: 64%

Refractory Tamponade: - Use Of Ultrasound Contrast Agent to Distinguish Aortic Dissection from Cardiorrhexis

Krantz¹

2014

J Cardiovasc Dis Diagn

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We report a case of a ruptured proximal aortic dissection with cardiac tamponade, which masqueraded as myocardial rupture or cardiorrhexis. An 84-year-old female had sudden onset of chest pain with loss of consciousness and a mechanical fall. Echocardiography demonstrated pericardial effusion with hematoma overlying the apicallateral wall and an echo free space suggestive of contained, ventricular free-wall rupture. However, intravenous injection of ultrasound contrast agent revealed no flow into the pericardial space excluding cardiorrhexis. Refractory hemodynamic compromise required an emergency pericardial window, but the patient remained unstable. Surgical exploration revealed a Debakey Type-A aortic dissection with communication into the pericardial space. To our knowledge, this is the first description of the use of ultrasound contrast microbubbles as a diagnostic strategy to exclude cardiorrhexis. The impact of tamponade treatment as the result of aortic dissections and the diagnostic challenge in differentiating it from other catastrophic causes of tamponade are reviewed.

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Section: Discussionmentioning

confidence: 64%

Refractory Tamponade: - Use Of Ultrasound Contrast Agent to Distinguish Aortic Dissection from Cardiorrhexis

Krantz¹

2014

J Cardiovasc Dis Diagn

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“…Numerous reports exist of normotension or moderately increased blood pressure during tamponade [9,10,11] and there has been at least one report of malignant hypertension in this setting [12]. While not part of Beck’s triad, dyspnea is a common manifestation of cardiac tamponade in medical patients.…”

Section: Discussionmentioning

confidence: 99%

Pericardial Effusion in Renal Disease: To Tap or Not to Tap

Krantz

Byrd

2011

Cardiology

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The natural history of pericardial effusions attributable to renal disease is variable. Although aggressive hemodialysis may lead to the resolution of some effusions, some reports suggest that prompt drainage is optimal. We describe a case of a 49-year-old woman who presented with end-stage renal disease and a large pericardial effusion. Although she was hypertensive on presentation and had no pulsus paradoxus, transthoracic echocardiography revealed stigmata of cardiac tamponade, including right atrial and ventricular collapse, as well as a plethoric inferior vena cava. Because of the lack of certain clinical signs of tamponade and due to concern about excess bleeding risk in the setting of uremia, the effusion was initially managed with serial dialysis rather than pericardiocentesis. The effusion did not decrease in size despite 1 week of hemodialysis, and the patient developed acute dyspnea, relative tachycardia and hypotension after an increase in the blood flow rate during hemodialysis, all of which resolved with a decrease in the blood flow rate. The onset of dyspnea during a session of dialysis as a symptom of tamponade physiology has not been reported previously. We believe that this case supports early pericardiocentesis in patients with any degree of echocardiographic evidence of tamponade. We discuss this in the context of existing literature, which suggests that pericardiocentesis, rather than dialysis, is the preferred management strategy for large uremic pericardial effusions, even in the absence of evidence of clinical signs of pericardial tamponade.

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