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The patient with acute cardiovascular problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Cardiac tamponade (see also Chapter 7) occurs when the normal 30–50mL of fluid between the layers of the pericardium increases to such an extent that diastolic filling is impeded due to the pressure exerted on the heart. A rapid accumulation of as little of 50mL can be sufficient to cause cardiac arrest, though a gradual build-up of a pericardial effusion can accommodate up to 1000mL. Immediate medical intervention of pericardiocentesis is required to relieve the pressure so the ventricle can fill, and cardiac output can be maintained.
Pericardial disease in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Pericardial fluid analysis is often performed when the patient is undergoing a therapeutic pericardiocentesis, say in case of cardiac tamponade. Pericardiocentesis for primary diagnostic purposes should be performed only in very rare clinical situations and must be critically weighed for a risk-benefit ratio of the procedure. The diagnostic yield of the procedure is relatively low, and many low-risk patients can be managed empirically without making a specific diagnosis (4). In about 60% of the patients, diagnosis can be made using a suspected etiology-based approach accounting the three factors described previously (10,37). Pericardiocentesis should be reserved for the following conditions in pericardial effusion: (1) cardiac tamponade or impending hemodynamic instability; (2) suspected malignancy or metastatic disease; (3) clinically suspected purulent or tuberculous pericarditis; and (4) moderate to large pericardial effusions (>10–20 mm) if the effusion persists and is symptomatic (4,10).
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
If extensive fluid collects within the pericardial cavity it interferes with the action of the heart since the fibrous pericardium is inelastic. The pericardial cavity, in this way, behaves like a rigid box with only a finite amount of space. Thus, if the pressure builds up within the compartment, something else has to give and this usually results in compression of the heart. Such a situation is most commonly encountered in the case of penetrating trauma where the build-up of blood within the pericardial space often results in a cardiac tamponade, manifesting as a precipitous fall in cardiac output (CO). Pericardiocentesis (removal, by needle, of pericardial fluid) may be a life-saving manoeuvre in such circumstances.
Pericardiocentesis by an Air Medical Service for Cardiac Tamponade Caused by Purulent Pericarditis
Published in Prehospital Emergency Care, 2023
Timothy Boardman, Nicholas North, Sara Sullivan
Pericardiocentesis is an infrequently performed procedure and it is not uncommon for physicians performing emergency care to feel uncomfortable performing it (15). Emergency medicine residency graduates are only required to have performed three pericardiocentesis procedures prior to graduation, and this requirement can be met through simulation alone. It is not uncommon for graduating residents to have never performed this procedure on a live patient (16). Once pericardiocentesis was performed in this case, there was an immediate improvement of hemodynamics that allowed for the safe transportation of the patient. The use of an over-the-needle angio-catheter to perform the pericardiocentesis allowed for the placement of the catheter in the pericardium and facilitated repeat drainage of fluid during the transport when the patient re-developed tamponade physiology. The placement of a pericardial catheter using the over-the-needle technique is recommended and has been demonstrated to be an effective method of performing prehospital pericardiocentesis (14).
Large hemopericardium and pericardial tamponade from presumed erosion of a Watchman 2.5 device 1-year postimplantation
Published in Baylor University Medical Center Proceedings, 2022
Raveen Chawla, Collin Troester, Timothy A. Mixon
He presented to the hospital 1 year later with fatigue and dyspnea. He was found to be hypotensive and in shock, requiring multiple vasopressors. A chest computed tomography (CT) scan showed a large hemopericardium with tamponade features, with evidence of bleeding at the location of the Watchman device (Figure 2). An echocardiogram corroborated the CT findings. The patient underwent emergent pericardiocentesis with removal of 500 cc of sanguineous fluid. This resulted in improvement of hemodynamics; however, the patient had already developed profound multiorgan failure with elevated levels of lactic acid, aspartate transferase, and alanine transaminase. The shock and hemopericardium were suspected to be due to the erosion of the Watchman device. The family opted for palliative care, and the patient soon expired; autopsy was declined.
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
ATAAD patients should be performed operation as soon as possible. However, due to the limitations of objective factors, many patients may not be operated immediately. ATAAD patients with TMP usually die before surgery. Under the circumstances, pericardiocentesis is necessary to maintain circulation. For a long time, it has been controversial whether to perform pericardiocentesis. The European Society of Cardiology pointed out that pericardiocentesis was not recommended for patients with aortic dissection [24]. However, pericardiocentesis can be performed in patients with aortic dissection to maintain perfusion according to guidelines for diagnosing and managing patients with thoracic aortic disease [25]. A steep pressure-volume curve exists in the normal pericardial space. After the pericardial effusion rapidly increases to the limit of the pericardial reserve capacity, it will quickly exceed the limit of the pericardial wall pulling, resulting in a sharp increase in pressure [26]. Judging from the steep pericardial pressure-volume curves, the amount of fluid extracted from the pericardium should be small enough to maintain the circulation of ATAAD patients with TMP [26].