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Surgery and traumatology: Surgical management of severely injured patients when resources are limited
Published in Jan de Boer, Marcel Dubouloz, Handbook of Disaster Medicine, 2020
Suspicion of cardiac tamponade: high pulse rate, paradoxical pulse, and raised central venous pressure (dilated jugular veins). The diagnosis is best made by ultrasonography (rarely available outside hospital), paraxiphoid percutaneous punction of the pericardium, or, as a more safe and accurate procedure, opening of the pericardial sac through a small paraxiphoid incision.
Cardiac surgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
There is continuous production and resorption of pericardial fluid. If a disease process disturbs this balance a pericardial effusion may develop. If the pressure exceeds the pressure in the atria, compression will occur, venous return will fall and the circulation will be compromised. This state of affairs is called ‘tamponade’. A gradual build-up of fluid (e.g. malignant infiltration) may be well tolerated for a long period before tamponade occurs, and the pericardial cavity may contain 2 litres of fluid. Acute tamponade (from penetrating trauma, during coronary angiography or postoperatively) may occur in minutes with small volumes of blood. The clinical features are low blood pressure with a raised jugular venous pressure and paradoxical pulse. Kussmaul’s sign is a characteristic pattern that is seen when the jugular venous pressure rises with inspiration as a result of the impaired venous return to the heart.
Pericardiocentesis
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
Cardiac tamponade also has nonspecific physical find- ings, including paradoxical pulse, and inspiratory decrease in systemic venous pressure. Distant heart sounds when noted with the other physical findings are a further clue; however, this constellation of findings may be present in other disease states including severe obstructive lung dis- ease. Hemodynamic compromise includes hypotension (or a relative decrease from baseline pressure) and tachycardia (which may be masked by the presence of beta-blockers). As right-sided cardiac chamber filling decreases, so does stroke volume. The heart rate increases in an effort to maintain cardiac output. The most common noninva- sive method of determining the presence of tamponade is echocardiography. The presence of diastolic right heart chamber collapse on echocardiography is sensitive for tamponade.2,3
Perioperative Complications and Postoperative Mortality in Patients of Acute Stanford Type a Aortic Dissection with Cardiac Tamponade
Published in Journal of Investigative Surgery, 2022
Dong Ji, Ziyi Wu, Hongyu Dai, Jing Yang, Xun Zhang, Jing Jin, Qingguo Li, Hao Yao
Computed tomography angiography (CTA) is the first choice for diagnosing aortic dissection recommended by guidelines [12]. TMP was clinically diagnosed as follows: (1) Echocardiography: A large amount of pericardial effusion existed in the pericardial space during diastole; other signs included swinging of the heart, the early diastolic collapse of the right ventricle, the late diastolic collapse of the right atrium, abnormal ventricular septal motion, exaggerated respiratory variability(>25%) in mitral inflow velocity, inspiratory decrease and expiratory increase in pulmonary vein diastolic forward flow [13–16]. (2) The electrocardiogram showed signs of pericardial tamponade, with especially low QRS voltages and electrical alternan. (3) Clinical signs included tachycardia, hypotension, paradoxical pulse, jugular vein engorgement, and muffled heart sounds.
Global epidemiology and changing clinical presentations of invasive meningococcal disease: a narrative review
Published in Infectious Diseases, 2022
Ala-Eddine Deghmane, Samy Taha, Muhamed-Kheir Taha
Cardiac manifestations are quite common during IMD and myocarditis was revealed by autopsy in 35% of patients with disseminated meningococcemia in the 1960s of the twentieth century [55] as was also suggested by data from experimental infection in mice [56]. However, they are rarely observed in clinical practice. Few case reports were described although their frequency was higher before the antibiotics era [27,57–59]. Moreover, they can be associated with immune-compromised status of the patient such as concomitant infection by the human immunodeficiency virus [60]. In series of 2091 cases of IMD confirmed by culture between 1999 and 2002 in France, 6 cases of pericarditis were reported (3 serogroups C, 2 serogroups W and 1 serogroup Y) [27]. The link with the isolates belonging to the hyperinvasive genetic lineage, in particular the CC11, was reported in several countries [28–30,61] and the recent emergence of the hyperinvasive isolates W/CC11 can be associated with an increase in these forms [54]. During an episode of IMD, if chest pain, tachycardia, polypnea, tamponade, and paradoxical pulse appear, ECG that reveals abnormalities (ST segment elevation) is needed and echocardiographic is required.
Central Nervous System and Cardiac Involvement in the Hypereosinophilic Syndrome: A Case Report
Published in Immunological Investigations, 2021
Reza Kiani, Batoul Naghavi, Ahmad Amin, Anita Sadeghpour, Ali Zahedmehr, Ata Firouzi, Hamid Reza Pouraliakbar, Saeed Ebrahimi Meymand, Armin Marashizadeh, Simin Almasi
On physical examination she was ill, blood pressure was 110/79 mm Hg with the positive paradoxical pulse, heart rate and oxygen saturation were 88 beats/min and 96%, respectively, and she had no fever and optic disk edema. She demonstrated mildly elevated jugular veins, decreased sound at the bases of the lungs, and muffled heart sounds.