Transient acute left ventricular dysfunction post-pericardiocentesis for cardiac tamponade

Abstract

IntroductionAcute left ventricular heart failure is an uncommon but serious complication of pericardiocentesis. However, its exact mechanism remains unknown. In this report, we present a case of a 65-year-old male patient with hemopericardium and cardiac tamponade who developed acute left ventricular heart failure after pericardiocentesis. Case reportA 65-year-old male patient was admitted to our institution with a 1-month history of intermittent lower chest discomfort and dyspnea that was worse on exertion. His past medical history was unremarkable except for mild gastritis, diverticulosis, and a gradual loss of weight of 4 kg over the past 2 months. He was a chronic smoker of 50 pack years but did not have diabetes, hypertension, or dyslipidemia.On physical examination, blood pressure, heart rate, and respiratory rate were within normal ranges. Cardiovascular examination was unremarkable. Significantly, the patient did not have muffled heart sounds or raised jugular venous pulsations. Electrocardiogram showed sinus rhythm with low voltage QRS complexes. Chest X-ray ( Fig. 1A) revealed an enlarged cardiac silhouette with mild pulmonary venous congestion. Routine blood tests were largely unremarkable except serum sodium of 128 mmol/L and hemoglobin of 11.5 g/dl. Serial cardiac enzymes were within normal ranges.Transthoracic echocardiogram (Fig. 1B) demonstrated a large circumferential pericardial effusion with right atrial diastolic collapse. The echocardiographic measurements of the pericardial effusion were posterior to left ventricle = 2.1 cm; adjacent to left ventricle apex = 2.8 cm; anterior to right ventricle = 2.8 cm; adjacent to right ventricle = 1.7 cm. The inferior vena cava was plethoric with diminished respiratory variation. Left ventricular systolic function was preserved, and there was no observable regional wall motion abnormality. The ejection fraction was estimated at 60-65%. Uncomplicated therapeutic pericardiocentesis under fluoroscopic guidance was performed and 700 ml of hemoserous fluid was drained. A pericardial pigtail catheter was left to drain the remaining pericardial fluid.Immediately post-pericardiocentesis, blood pressure was 136/82 mmHg, compared to 120/60 mmHg pre-procedure. Eight hours post-pericardiocentesis, the patient developed hypotension with a blood pressure of 80/60 mmHg, pulse rate of 85 beats per minute, respiratory rate of 21 breaths per minute and SpO 2 100% on 2 L/min of intranasal oxygen. He was resuscitated with intravenous crystalloids and started on intravenous dopamine infusion. Electrocardiogram (Fig. 2C) that was repeated showed sinus rhythm with new-onset hyperacute T waves in the anterolateral leads, compared to baseline (Fig. 1C). Serum cardiac Journal of Cardiology Cases xxx (2015) xxx-xxx A B S T R A C T A rare but serious complication of pericardiocentesis is the development of transient left ventricular dysfunction. In this report, we present a case of a 65-year-old male patient with cardiac tamponade who suffered from acute left ventricular heart failur...

Pericardial Decompression Syndrome: A Comprehensive Review of a Controversial Entity

“…Two (2.8%) cases reported new-onset right to left shunt occurring after right ventricular failure. 5 7 8 9 10 11 12 14 15 16 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74…”

Low cardiac output syndrome requiring extracorporeal membrane oxygenation following pericardiocentesis in an adolescent with Hodgkin Lymphoma: a case report

“…6 First, if the high right ventricular pressure/volume ratio is decreased with a sudden decompression of cardiac tamponade, it could cause a disproportional increase in right ventricular end-diastolic volume, which then increases wall stress and end-diastolic pressure of the left ventricle. 9 A second mechanism is myocardial stunning due to oxygen supply demand mismatch across the left ventricular and right ventricular myocardium. 9 In this case it is possible that both mechanisms were included.…”

“…9 A second mechanism is myocardial stunning due to oxygen supply demand mismatch across the left ventricular and right ventricular myocardium. 9 In this case it is possible that both mechanisms were included. In reported cases of tamponade in patients with Hodgkin Lymphoma, 2,10 cardiac failure demanding treatment with V-A ECMO in an adolescent has not yet been reported.…”