Presentation
A significant number of patients present in a subacute fashion and can be successfully treated with surgery if diagnosed promptly. We present a case of subacute free-wall rupture that occurred after an undiagnosed myocardial infarction. [ncbi.nlm.nih.gov]
Entire Body System
- Weakness
Six weeks later, she was hospitalized after complaints of weakness and dizziness, and a chest radiograph revealed cardiomegaly. [ncbi.nlm.nih.gov]
[…] persistent atrial fibrillation, on apixaban, aortic and mitral bioprosthetic valve replacement, dual-chamber permanent pacemaker (PPM) implantation for heart block 2 weeks prior presented with worsening shortness of breath, dry cough, and generalized weakness [shmabstracts.org]
His only complaint other than feeling generally weak was being “sweaty.” He denied any injury, pain, fever, vomiting, melena, or shortness of breath and said he had been fine all day until he suddenly got sweaty and passed out. [patientcareonline.com]
Auscultation showed impalpable cardiac tones, vesicular breathing in lungs, which was weak in lower parts. There was hepatomegalia. The liver was 4 cm below the costal arch. [mine-med.ru]
- Inflammation
Histologically, there was a zonal medial necrosis with surrounding chronic inflammation, focal destruction of the media, and fibrosis of the intima and adventitia. A diagnosis of granulomatous necrotizing aortitis of Takayasu type was made. [ncbi.nlm.nih.gov]
The final pathology revealed chronic inflammation and there was no malignancy, and no bacteria or mycobacterium were seen. [doi.org]
Most commonly, the fluid is exudative and results from pericardial injury or inflammation. [emedicine.medscape.com]
Pericardial biopsy was suggestive of acute inflammation and pericardial fluid culture was sterile. The child was asymptomatic with normal cardiac function at follow-up after 6 months. [indianpediatrics.net]
Complete exploration of the heart revealed no evidence of aortic or coronary dissection, no cardiac chamber bleeding, no epicardial inflammation, and normal pericardial thickness. [emra.org]
- Anemia
Initial laboratory studies revealed baseline normocytic anemia and elevation in ferritin, CRP, and D-dimer levels. Chest XRay demonstrated cardiomegaly and a new 4cm right upper lung (RUL) mass. [jacc.org]
Labs at the time of ED arrival showed no evidence of thrombocytopenia, uremia, coagulopathy, or anemia. [emra.org]
Routine laboratory tests revealed anemia, neutrophilic leukocytosis, thrombocytopenia, hypoalbuminemia, hyponatremia, hyperglycemia; elevated levels of transaminases, urea and creatinine; and urinalysis showed hematuria, high sodium concentration and [scielo.org.mx]
Besides taking ferrofumarate and cholecalciferol for iron-deficiency anemia and vitamin D deficiency, she had no previous medical history. [frontiersin.org]
[…] hemodialysis, severe coronary artery disease requiring multiple percutaneous interventions, paroxysmal atrial fibrillation on warfarin, chronic obstructive pulmonary disease on multiple inhalers, obstructive sleep apnea on continuous positive airway pressure, anemia [jeccm.amegroups.com]
- Atrial Septal Defect
OBJECTIVE: Since 1976 a number of similar transvenous atrial septal defect occlusion systems have been developed and applied to prevent surgical intervention with extracorporeal circulation and the complications involved. [ncbi.nlm.nih.gov]
I23 Certain current complications following ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction (within the 28 day period) I23.0 Hemopericardium as current complication following acute myocardial infarction I23.1 Atrial septal defect [icd10coded.com]
septal defect (ASD) closure, left atrial appendage occlusion Trauma to the chest Cardiovascular surgery - Postoperative pericarditis [5] Postmyocardial infarction - Free wall ventricular rupture, Dressler syndrome Connective tissue diseases - Systemic [emedicine.medscape.com]
Gastrointestinal
- Severe Abdominal Pain
New-onset severe abdominal pain, worsening leukocytosis to 16.6 and transaminitis (AST 1,859 and ALT 1,661 units per liter) concerning for hepatocellular ischemia were also noted. [jeccm.amegroups.com]
Cardiovascular
- Hypotension
Massive bleeding through the chest drains with hypotension required emergency reoperation in the intensive care unit. The patient was discharged home on postoperative day 11. [ncbi.nlm.nih.gov]
In the field she was hypotensive and responded to vigorous fluid resuscitation. At the trauma center, initial chest radiography ( Fig. 1A ) showed enlargement of the superior mediastinum. [doi.org]
- Hypertension
We describe an autopsy case of a 45-year-old man with hypertension who died suddenly following both of these conditions. He had been treated for hypertension; the finding of arteriolar nephrosclerosis supported the existence of the disease. [ncbi.nlm.nih.gov]
Amongst other risk factors, untreated mild to moderate hypertension is associated with a 30% risk of atherosclerotic disease. [scholarworks.wmich.edu]
- Pulsus Paradoxus
However, collapses need not be present even in florid tamponade and particularly in some cases with chamber hypertrophy.2 Similarly, the absence of pulsus paradoxus correlates well with left ventricular hypertrophy.3 Moreover, the initially high blood [ahajournals.org]
At admission, the heart rate was 112 bpm, and the patient had elevated jugular venous pressure, pulsus paradoxus, and distant heart sounds on auscultation. [academic.oup.com]
Detection of pulsus paradoxus associated with large pericardial effusions in pediatric patients by analysis of the pulse-oximetry waveform. Pediatrics. 2002;109:673–77. [PubMed] [Google Scholar] 13. Ariyarajah V, Spodick DH. [ncbi.nlm.nih.gov]
Detection of pulsus paradoxus associated with large pericardial effusions in pediatric patients by analysis of the pulse-oximetry waveform.Pediatrics. 2002;109:673–77. [PubMed] 13. Ariyarajah V, Spodick DH. [westjem.com]
- Heart Disease
Pulmonary artery dissection is associated with pulmonary artery aneurysm, pulmonary artery hypertension, and congenital heart disease. [ncbi.nlm.nih.gov]
Patrick Wouters 13.50 – 14.10 Echo in ARDS: influence of mechanical ventilation on the right heart. Isabelle Michaux 14.10 – 14.30 Tricuspid assessment in left heart disease. Fabio Guarracino 14.30 – 14.50 Contrast echocardiography in ICU. [baltanest2016.com]
ICD-10-CM Codes › I00-I99 Diseases of the circulatory system › I30-I52 Other forms of heart disease › I31- Other diseases of pericardium › Hemopericardium, not elsewhere classified 2016 2017 2018 2019 Billable/Specific Code I31.2 is a billable/specific [icd10data.com]
- Thrombosis
ET is characterized by elevated platelet counts that can lead to thrombosis but paradoxically it can also lead to a bleeding diathesis. [creighton.pure.elsevier.com]
In six individual cases, these devices were explanted because of thrombosis, residual shunts, deformations of the umbrella, disconnection of the system and atrial perforation with hemopericard. This occured 17-380 days after the implant. [ncbi.nlm.nih.gov]
[…] complication following acute myocardial infarction I23.4 Rupture of chordae tendineae as current complication following acute myocardial infarction I23.5 Rupture of papillary muscle as current complication following acute myocardial infarction I23.6 Thrombosis [icd10coded.com]
Our patient presented with concomitant Stanford type A AD and left common iliac arterial thrombosis. It presents a therapeutic dilemma as the management of arterial thrombosis usually involves inhibition of the coagulation cascade. [pubs.sciepub.com]
Direct oral anticoagulants (DOACs) have become the preferred anticoagulant medication for patients with nonvalvular atrial fibrillation, deep vein thrombosis, and pulmonary embolism. [emra.org]
Musculoskeletal
- Fracture
This life-threatening complication resulted from penetration of a fractured metal plate through the pericardium into the right atrium. The clinical details are reported and discussed. [ncbi.nlm.nih.gov]
Common complications due to CPR include rib fractures, sternal fractures, bleeding in the anterior mediastinum, heart contusion, hemopericardium, upper airway complications, damage to the abdominal viscus - lacerations of the liver and spleen, fat emboli [diki.pl]
Left-side multiple fragmentary fractures of the ribs (arrows). [mine-med.ru]
[…] of the Lower Leg S 861 A Study of Conservative and Operative Treatment of AnkleJoint Fractures S 862 Indications Techniques and Results in Alloarthro plasty of the Hip after Subtrochanteric and Pertrochanteric Fractures S 863 Possibilities of and Experiences [books.google.de]
- Arthritis
雑誌 Arthritis Res 4:337-45 (2002) DOI: 10.1186/ar595 文献 PMID: 15702367 著者 Shayan K, Ho M, Edwards V, Laxer R, Thorner PS タイトル Synovial pathology in camptodactyly-arthropathy-coxa vara-pericarditis syndrome. [genome.jp]
View Article PubMed Google Scholar Stables RH, Campbell S, Ormerod OJ: Haemopericardium in rheumatoid arthritis. Int J Cardiol. 1989, 23 (2): 268-70. 10.1016/0167-5273(89)90260-X. [diagnosticpathology.biomedcentral.com]
Additional viral serology (adenovirus, coxsackievirus, echovirus, borrelia burgdorferi, cytomegalovirus, Epstein-Barr virus, and parvovirus), immunological testing (systemic lupus erythematosus, rheumatoid arthritis, vasculitis, complement screening, [frontiersin.org]
[…] atrial appendage occlusion Trauma to the chest Cardiovascular surgery - Postoperative pericarditis [5] Postmyocardial infarction - Free wall ventricular rupture, Dressler syndrome Connective tissue diseases - Systemic lupus erythematosus, rheumatoid arthritis [emedicine.medscape.com]
Neurologic
- Agitation
When initially aspirated fluid is bloody, it is imperative to inject agitated saline via an angiocatheter, as in this video, to ascertain that the catheter is in the pericardial space rather than a cardiac chamber. [edhub.ama-assn.org]
Urogenital
- Uremia
The 2 cases discussed below represent another example of hemorrhagic tendency associated with chronic uremia — namely, hemopericardium with cardiac tamponade. [nejm.org]
18% in acute uremia Other causes Serous fluid or transudate Congestive heart failure Hypoalbuminemia Irradiation Blood (hemopericardium) Rupture of ascending aorta or pulmonary trunk Coagulopathy Fibrin (produces exudate) Pyogenic infection, e.g. staph [learningradiology.com]
In the absence of uremia,5 this should have been a signal that something critical was afoot (we are not told the effect of atropine therapy, but it is likely to have been unsuccessful). [ahajournals.org]
In patients with severe renal dysfunction, DOACs can accumulate, increasing the likelihood of bleeding complications.13 Dysfunctional platelets due to uremia pose an additional bleeding risk. [acc.org]
Hemopericardium with cardiac tamponade in chronic uremia. New England J. Med. 1957; 257: 230 Scopus (13) PubMed Crossref Google Scholar Weiss S. Wilkins R.W. Myocardial abscess with perforation of the heart. Am. J. M. [ajconline.org]
- Anuria
Pallor, perspiration, neck vein distention, tachycardia (108 beats/min), hypotension (93/58 mm Hg), and anuria were recognized. Moderate pericardial effusion without aortic valve regurgitation was disclosed on echocardiography. [jtcvs.org]
Workup
The infectious and inflammatory workup of pericardial fluid was negative, and the cause of hemopericardium was determined to be the micro-perforation of the ventricle from PPM lead which did not warrant lead revision. [shmabstracts.org]
Invasive diagnostic workup including surgery and histopathology, confirming the diagnosis angiosarcoma of the heart. [frontiersin.org]
It appears that all our patients experienced spontaneous hemopericardium while taking rivaroxaban as a thorough workup excluded other major etiologies. [clinmedjournals.org]
(See Presentation, Workup, Treatment, and Medication .) This anteroposterior-view chest radiograph shows a massive, bottle-shaped heart and conspicuous absence of pulmonary vascular congestion. Reproduced with permission from Chest, 1996: 109:825. [emedicine.medscape.com]
X-Ray
- Pericardial Effusion
Repeat TTE showed no re-accumulation of pericardial effusion. The patient recovered and was discharged in stable conditions with outpatient cardiology follow-up. [shmabstracts.org]
The patient had a large hyperdense pericardial effusion caused by accumulation of bloody fluid, leading to hypotension and shock. Approximately 1000 mL of hemorrhagic fluid was drained from the pericardial space. [ncbi.nlm.nih.gov]
When signs of pericardial effusion are manifested, patients often progress rapidly to CT (18). [jeccm.amegroups.com]
Moderate pericardial effusion without aortic valve regurgitation was disclosed on echocardiography. [jtcvs.org]
Treatment
We report successful treatment of man with acute spinal cord injury who presented with simultaneously diagnosed PTE and hemopericardium, a rare complication involving two distinct and opposing pathological mechanisms and conflicting treatments. [ncbi.nlm.nih.gov]
Sec., Jiapu Road, Puzih City, Chiayi Country 613, Taiwan (ROC); qcth3160{at}adm.cgmh.org.tw Abstract Acute cardiac tamponade requires urgent diagnosis and treatment. [doi.org]
Operative treatment of aortic dissections. Experience with 125 patients over a sixteen-year period. [jtcvs.org]
Prognosis
Prognosis It depends upon associated anomalies and upon cardiac function. The prognosis of nonimmune fetal hydrops is very poor with a perinatal mortality rate between 70 to 90 percent1. Management Sonography must search for signs of heart failure. [thefetus.net]
CT scanning may be used to confirm the diagnosis but is less helpful in complications and prognosis. [patient.info]
With adequate therapy prognosis in patients with uremic hemopericardium can be good. This is supported by an 83 per cent survival during a mean follow-up of nineteen months. [amjmed.com]
Prognosis Cardiac tamponade is a medical emergency. The prognosis depends on prompt recognition and management of the condition and the underlying cause of the tamponade. Untreated, cardiac tamponade is rapidly and universally fatal. [emedicine.medscape.com]
As a result, prognosis of cardiac angiosarcomas remains poor with survival ranging from 6 to 9 months after diagnosis (13). [frontiersin.org]
Etiology
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]
In conclusion, if hemopericardium is present without clear etiology in a patient with a retained EPW, a nearby mobile EPW may be the cause. [ncbi.nlm.nih.gov]
Etiology The etiology of hemopericardium in infants includes chest trauma either accidental or iatrogenic (i.e.: birth trauma, closed chest massage), generalized diathesis, pericardial teratomas, and rupture of cardiac aneurysms or diverticula2. [thefetus.net]
Hemopericardium: report of case of unknown etiology with recovery following two pericardial paracenteses. Review of etiology of hemopericardium. Am. Heart J. 1934; 9: 680 Scopus (1) Abstract Full Text PDF Google Scholar Fulton M.N. [ajconline.org]
Etiology There is a very long list of causes 1,2 but some of the more common are: ruptured myocardial infarction ruptured left ventricular aneurysm aortic dissection pericarditis trauma blunt/penetrating/deceleration iatrogenic, e.g. pacemaker wire insertion [radiopaedia.org]
Epidemiology
Epidemiology The incidence is approximately 3-4 per 100,000 per year. [ 2 ] Aortic dissection is the most common emergency affecting the aorta. The male:female ratio varies - in one study, almost 70% of cases were in males. [patient.info]
View Article PubMed Google Scholar Carbone M, Fisher S, Powers A, Pass HI, Rizzo P: New molecular and epidemiological issues in mesothelioma: role of SV40. J Cell Physiol. 1999, 180: 167-72. 10.1002/(SICI)1097-4652(199908)180:2 3.0.CO;2-Q. [diagnosticpathology.biomedcentral.com]
[…] patients undergoing heart valve surgery, cardiac tamponade has been associated with any amount of pericardial effusion at the first postoperative transthoracic echocardiography as well as with mechanical valve replacement of the aortic or mitral valve. [9] Epidemiology [emedicine.medscape.com]
Pathophysiology
Acute aortic syndrome, including classic aortic dissection, intramural aortic hematoma, and penetrating atherosclerotic ulcer (PAU), is a term used to describe a group of conditions with similar clinical symptoms, but with different pathophysiological [ncbi.nlm.nih.gov]
Timetable, The Little Hall 08:00 – 08:50 Registration, coffee 08:55 – 09:00 Welcome and introduction Indrek Rätsep 09.00 – 09.30 A systematic Echo approach to cardiovascular pathophysiology. [baltanest2016.com]
Uremic pericarditis, pericardial effusion, and constrictive pericarditis in end-stage renal disease: Insights and pathophysiology. Clin Cardiol 2017;40:839-46. [Crossref] [PubMed] De Pace NL, Nestico PF, Schwartz AB, et al. [jeccm.amegroups.com]
(See Pathophysiology, Etiology, and Prognosis .) The overall mortality risk depends on the speed of diagnosis, the treatment provided, and the underlying cause of the tamponade. [emedicine.medscape.com]
Understanding ventricular-vascular coupling helps in determining pathophysiology of cardiovascular manifestations [ 14 ]. [pubs.sciepub.com]
Prevention
Given her CHA2DS2VASc score of 3, she was started on warfarin for stroke prevention. One month later, she was admitted with cardiac tamponade. [ncbi.nlm.nih.gov]
DOACs approved by the United States Food and Drug administration (FDA) include dabigatran (VTE treatment and prophylaxis, NVAF for stroke prevention),1 rivaroxaban (VTE treatment and prophylaxis, NVAF for stroke prevention, prevention of major adverse [acc.org]