Transient Systolic Dysfunction after Relief of Cardiac Tamponade

Wolfe, Mark W.

doi:10.7326/0003-4819-119-1-199307010-00007

Cited by 61 publications

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“…While the exact pathophysiological mechanism for LV dysfunction following pericardiocentesis remains speculative, we believe that the abrupt disproportionate increase in LV wall stress, coupled with the chronicity of tamponade, may be critical determining factors (4)(5)(6). Myocardial stunning may play a contributory role, considering the almost complete and uniform recovery of function seen in previously reported cases and in our patient, as verified by the homogeneity of two-dimensional strain measurements.…”

Section: Discussionsupporting

confidence: 76%

Acute pulmonary edema following pericardiocentesis for cardiac tamponade

Bernal

Pradhan

et al. 2007

Canadian Journal of Cardiology

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A 45-year-old Caucasian woman with recently diagnosed acute myelogenous leukemia was admitted to hospital with complaints of right lower extremity swelling and progressively worsening dyspnea. Her past history included Hodgkin's lymphoma (in remission). Doppler ultrasound of her lower extremities ruled out deep venous thrombosis. On day 3 of hospitalization, the patient complained of shortness of breath at rest and cough. On physical examination, she had engorged jugular veins, tachycardia and a pulsus paradoxus of 20 mmHg. An electrocardiogram (ECG) demonstrated sinus tachycardia, low voltage and electrical alternans. The chest x-ray was unremarkable except for small bilateral pleural effusions. Emergent transthoracic echocardiography (TTE) showed normal left ventricular (LV) wall motion and an ejection fraction of 60% to 65%. Moderate circumferential pericardial effusion with compression of the right heart chambers and echocardiographic evidence of tamponade was noted.Echocardiography-and fluoroscopy-guided pericardiocentesis was performed for incipient tamponade, and approximately 500 mL of serosanguinous fluid was drained. A pigtail catheter was left in place.Cytological evaluation did not demonstrate any malignant cells.Six hours following the pericardiocentesis, the patient became hypotensive, tachypneic and tachycardic, requiring endotracheal intubation and inotropic support. A repeat TTE showed midanterior and anteroseptal akinesis, apical sparing and moderate LV dysfunction with an estimated ejection fraction of 30%. Minimal residual pericardial fluid was observed. A 12-lead ECG showed sinus tachycardia without ST-T changes. Chest x-ray showed pulmonary edema. Cardiac biomarkers, including troponin I, demonstrated minimally elevated values, with a peak value of 1.2 μg/mL (normal peak: 0.40 μg/mL). Cardiac magnetic resonance imaging (CMR) was performed to assess for myocarditis and myonecrosis. No evidence of delayed enhancement following gadolinium contrast was identified (Figure 1). The patient remained in cardiogenic shock for approximately 72 h, requiring ventilatory and inotropic support. Serial TTE showed progressive improvement in systolic function, and the patient was weaned off inotropic and CASE REPORT ©2007 Pulsus Group Inc. All rights reserved JM Bernal, L Afonso, J Pradhan, T Li. Acute pulmonary edema following pericardiocentesis for cardiac tamponade. Can J Cardiol 2007;23(14):1155-1156.Pericardiocentesis for therapeutic drainage of pericardial fluid may be associated with a variety of complications, including laceration of the right ventricle or coronary artery, arrhythmias, viscus perforation, hypotension, pneumothorax, adult respiratory distress syndrome and death. Hemodynamic derangements such as acute left ventricular failure, pulmonary edema and cardiogenic shock are infrequent and, hence, less well recognized. The present report describes a patient with pericardial effusion and tamponade who developed cardiogenic shock requiring inotropic support shortly following uncomplicated ultr...

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Section: Discussionsupporting

confidence: 76%

Acute pulmonary edema following pericardiocentesis for cardiac tamponade

Bernal

Pradhan

et al. 2007

Canadian Journal of Cardiology

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“…Although pericardiocentesis is usually well-tolerated, pulmonary edema, circulatory collapse, and acute RV and LV dysfunction have been reported after drainage of the pericardial effusion [61,62]. We have also observed an extreme vagal reaction in one patient with consecutive sinus bradycardia and 2nd degree AV block requiring atropine and transient ventricular pacing.…”

Section: Safety Of Fluoroscopy-guided Pericardiocentesismentioning

confidence: 67%

Pericardial Access and Drainage: Standard Techniques

Maisch

Ristić²,

Seferović³

et al. 2011

Interventional Pericardiology

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“…Vasovagal response to pericardial decompression occurs in up to 25% of patients and may be hemodynamically significant [5]. Successful pericardial decompression may also induce hemodynamic derangements such as acute left ventricular dysfunction, pulmonary edema, and cardiogenic shock that are unrelated to anatomic injury [6][7][8][9]. Finally, pericardiocentesis may fail to relieve the tamponade, especially when the pericardial effusion is loculated or rapidly re-accumulating.…”

Section: Discussionmentioning

confidence: 94%

Transient acute left ventricular dysfunction post-pericardiocentesis for cardiac tamponade

Sng

Koh

Lomarda

et al. 2015

Journal of Cardiology Cases

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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...

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Transient Systolic Dysfunction after Relief of Cardiac Tamponade

Cited by 61 publications

References 0 publications

Acute pulmonary edema following pericardiocentesis for cardiac tamponade

Acute pulmonary edema following pericardiocentesis for cardiac tamponade

Pericardial Access and Drainage: Standard Techniques

Transient acute left ventricular dysfunction post-pericardiocentesis for cardiac tamponade

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