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Pericardiocentesis


Presentation

Falling
  • Plasma atrial natriuretic peptide concentrations rose sharply from 42 pmol l-1 to a maximum of 150 pmol l-1 with a corresponding fall in mean right atrial pressure from 20 mmHg to 6 mmHg.[ncbi.nlm.nih.gov]
  • Pericardiocentesis: Technique 42 Cardiac tamponade relieved if (a) Pericardial pressure falls to a level 0 mm Hg and separates from the right atrial pressure (b) Right atrial pressure itself falls to the normal range and exhibits return of the normal[slideshare.net]
  • As the effusion becomes larger, impaired filling becomes worse and both cardiac output and blood pressure fall, eventually to levels that are insufficient to sustain life.[cathlabdigest.com]
Atrial Septal Defect
  • Significant hypoxemia can result from right-to-left intracardiac shunting through a patent foramen ovale, an atrial septal defect or a ventricular septal defect.[ncbi.nlm.nih.gov]
  • On the basis of echocardiography, a diagnosis of ostium primum atrial septal defect (OPASD) with effusive chronic constrictive pericarditis was made.[annals.in]
  • Septal Defect closure 13 years prior) Weeks P then S Transudate 500 mls then 100 mls Days Dyspnoea, pleuritic chest pain LVF, RVF, CS Anguera (1996) [ 27 ] 68 F History of bowel cancer, anorexia and dyspnoea for 1 month Weeks P Malignant 800 mls Minutes[cardiovascularultrasound.biomedcentral.com]
Hypoxemia
  • Significant hypoxemia can result from right-to-left intracardiac shunting through a patent foramen ovale, an atrial septal defect or a ventricular septal defect.[ncbi.nlm.nih.gov]
  • With decreased oxygen, a gas vital to life, the body cannot function properly and one can suffer from serious hypoxemia (oxygen deficiency) and worst - death.[docdoc.com]
Respiratory Distress
Regurgitation
  • A transthoracic echocardiogram performed 24 h later showed improved motion of the RV and the tricuspid valve, resulting in a reduction in tricuspid regurgitation.[ncbi.nlm.nih.gov]
  • A 75-year-old man with coronary artery disease, atrial fibrillation, sick sinus syndrome with permanent pacemaker, hypertension, dyslipidemia, and previous exertional dyspnea related to moderately severe mitral regurgitation from myxomatous degeneration[ahajournals.org]
  • Post bypass TEE revealed mild tricuspid regurgitation with a RVSP of 36 mm Hg.[annals.in]
Left Ventricular Dysfunction
  • The patient developed an early left ventricular dysfunction after removal of the pericardial effusion, with complete recovery within 10 days.[ncbi.nlm.nih.gov]
  • Transitory left ventricular dysfunction after pericardiocentesis is a rare complication and its exact incidence is unknown.[revespcardiol.org]
  • An unusual complication following pericardiocentesis: reversible left ventricular dysfunction. J Cardiovasc Med. 2015;16 Suppl 2:S133–5. View Article Google Scholar Sevimli S, Arslan S, Gundogdu F, Senocak H.[cardiovascularultrasound.biomedcentral.com]
Refractory Shock
  • We conclude that high-volume hemofiltration can be helpful as an adjuvant treatment for refractory shock after pericardiocentesis for chronic cardiac tamponade. The mechanism of the observed hemodynamic improvement remains to be investigated.[ncbi.nlm.nih.gov]
Ulcer
  • We describe a geriatric patient having a pneumopericardium from pericardial penetration by a gastric ulcer.[ncbi.nlm.nih.gov]

Workup

  • The aim of this study was to examine the etiology of pericardial effusions requiring a percutaneous intervention, either because of hemodynamic compromise or for a diagnostic workup, to determine how often fluid cytology is requested in unsuspected as[ahajournals.org]
Ejection Fraction Decreased
  • Left ventricular ejection fraction decreased to 20%, and there was akinesis in the left ventricular apex, and severe hypokinesis in the septum. The amount of daily drainage was decreased to 250 ml.[ncbi.nlm.nih.gov]

Treatment

  • High-volume hemofiltration was used as a rescue therapy after treatment with positive inotropic drugs proved ineffective.[ncbi.nlm.nih.gov]

Prognosis

  • CONCLUSIONS: The interval between cancer diagnosis and NCT onset, the impact of NCT on prognosis, and the prognosis after pericardiocentesis differed according to cancer type.[ncbi.nlm.nih.gov]
  • Prognosis following repeated drainages is less good. Guarded/poor prognosis for septic pericarditis and neoplasia. Further Reading Publications Refereed papers Recent references from PubMed and VetMedResource.[vetstream.com]

Etiology

  • Among etiologies, malignancy remains the most common cause of clinically significant pericardial effusion and is associated with a poor prognosis.[ncbi.nlm.nih.gov]

Epidemiology

  • Epidemiological data, procedure indications and etiology of the effusions were also recorded.[ncbi.nlm.nih.gov]
  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
  • Epidemiology : Pericardial effusions : Small pericardial effusions are found in 3.4% of the general population during autopsy Increased prevalence in HIV patients from 5-43% Parasternal Long View – Normal 21% of lung, breast, leukemia patients have metastases[coreem.net]
Sex distribution
Age distribution

Pathophysiology

  • Since transient ventricular dysfunction after pericardiocentesis is a very unusual complication, we present a review of the different mechanisms suggested in the literature to explain the pathophysiology of this rare phenomenon.[ncbi.nlm.nih.gov]
  • Epidemiology and pathophysiology of Takotsubo syndrome. Nat Rev Cardiol. 2015;12:387–9. View Article PubMed Google Scholar Yeh RW, Yu PB, Drachman DE.[cardiovascularultrasound.biomedcentral.com]
  • […] metastases to the pericardium, resulting in effusions Tamponade : Incidence is 2/10,000 in the USA Causes: Malignancy Infection (bacterial or tubercular pericarditis) Idiopathic pericarditis Trauma Uremia Hypothyroidism (myxedema) Lupus Post-radiation Pathophysiology[coreem.net]

Prevention

  • Adjunctive imaging decreases procedural risk for difficult-to-access pericardial fluid collections and must be used to prevent inadvertent morbidities.[ncbi.nlm.nih.gov]
  • In this modern age when imaging guidance is more prevalent, complications from deep or inappropriate needle insertion may be prevented.[jove.com]

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