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Cardiovascular system
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
8.4. In which of the following is pulsus paradoxus likely to be present?Pericardial fluid collection due to heart failure.Rheumatic pericarditis.Pneumothorax.Severe asthma.Pericardial fluid collection due to Dressler's syndrome (post-pericardiotomy syndrome).
Pre-Hospital and Emergency Trauma Care
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Pericardial tamponade is most commonly encountered in patients with penetrating injuries to the torso. Approximately 25% of all patients with cardiac injuries will reach the ED alive. The diagnosis is often obvious. The patient has distended neck veins and poor peripheral perfusion, and a few will have pulsus paradoxus. Ultrasonography may establish the diagnosis in those few patients with equivocal findings. Pericardiocentesis is of doubtful diagnostic or therapeutic use; ultrasound is a more reliable diagnostic modality, and a subxiphoid pericardial window is preferable therapeutically. However, proper treatment is immediate thoracotomy, preferably in the operating room, although ED thoracotomy can be life-saving.10
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
Urgent echocardiography is often needed in a case of suspected cardiac tamponade. Typical echocardiographic findings in tamponade include late diastolic collapse of the RA and early diastolic collapse of the RV, especially when the intrapericardial pressure exceeds the intracavitary pressure (38). The maximal pericardial pressure in tamponade occurs during end-diastole, when the RA volume is minimal, causing right atrial buckling. Persistence of RA collapse for more than one-third of the cardiac cycle is highly sensitive and relatively specific for tamponade (5,6). Left ventricular collapse, which can also occur in tamponade, is highly specific (though not as sensitive) for tamponade. Reciprocal changes occur in the RV and LV during respiration which indicate ventricular interdependence are quite simple to be detected as increased respiratory variability of transmitral E velocity >25% or tricuspidal E velocity >40% (5–7). The interventricular septum bulges into the LV during inspiration due to an increased systemic venous return to the RV and limited expansion of the RV free wall due to the increased intrapericardial pressure. The transmitral pressure gradient increases during expiration and subsequently, the systemic venous return decreases with reversal of diastolic flow in the hepatic veins. These findings contribute to pulsus paradoxus. Other echocardiographic findings in tamponade include inferior vena cava (IVC) dilatation (with less than a 50% reduction in its diameter during inspiration) (Figure 28.10), and the “swinging motion of the heart” within the pericardial sac.
Extrapulmonary tuberculosis
Published in Expert Review of Respiratory Medicine, 2021
Surendra K Sharma, Alladi Mohan, Mikashmi Kohli
The onset is insidious. Constitutional symptoms like fever, malaise, and weakness are present. Vague chest pain, dyspnea, cough, and weight loss are common. Pericardial TB can present acutely as acute pericarditis, cardiac tamponade, pericardial effusion, effusive constrictive pericarditis, or chronic constrictive pericarditis. Concurrent pleural involvement with effusion may be present. Pulsus paradoxus, raised jugular venous pressure, ascites, and dependent edema are common physical signs. A classical pericardial rub may also be heard; sometimes, it may be triphasic (audible in the atrial, ventricular systole, and ventricular diastole phases), heard over the left sternal border louder at inspiration and on bending forward [2]. Myocardial TB presents with idiopathic ventricular tachycardia or unexplained heart failure [17]. Myocardial TB is an underdiagnosed entity as the diagnosis of myocardial TB is difficult. Due to patchy distribution of the lesions, it may be missed even on endomyocardial biopsy.
Constrictive pericarditis decades after aortic valve repair
Published in Baylor University Medical Center Proceedings, 2020
Pericarditis can be acute or chronic. Acute pericarditis lasts <6 weeks; common etiologies include medications, postmyocardial infarction, and viral infections. Chronic pericarditis lasts >6 months and can lead to development of constrictive pericarditis. Etiologies of constrictive pericarditis include past cardiac surgeries, viral infections, radiation, trauma, or uremia. Our patient had no recent viral infections and no history of radiation, trauma, or uremia. Signs and symptoms of chronic pericarditis include elevated jugular venous pressure, pulsus paradoxus, and right heart failure symptoms, such as dyspnea, ascites, hepatomegaly, pitting edema, and pleural effusions.3 In patients with constrictive pericarditis, the pericardium becomes fibrotic and thickened. This leads to a decrease in compliance of the atria and ventricles, which decreases the blood return, subsequently causing the signs and symptoms described above. While ventricular interdependence is always present, constrictive pericarditis leads to a marked increase of ventricular interdependence due to the increase in right ventricular pressure, causing a decrease in left ventricular end diastolic volume.4
Multimodality imaging for the diagnosis and treatment of constrictive pericarditis
Published in Expert Review of Cardiovascular Therapy, 2019
Michael Chetrit, Natalie Natalie Szpakowski, Milind Y. Desai
The clinical presentation of effusive-constrictive pericarditis may contain elements of pericardial effusion or constriction, or a combination of both. Patients can present with pulsus paradoxus, a finding that is not typically associated with isolated constrictive pericarditis. Recent hypotheses suggest effusive-constrictive pericarditis is a transitional state wherein pericardial inflammation or effusion is resolving, and a fibrosing pericardium is beginning to form. Of note, in a recent series by Kim et al., from among 33 patients with the diagnosis effusive constrictive pericarditis, 31 patients had complete resolution of constrictive physiology either with anti-inflammatory medications or spontaneously, suggesting an overall favorable prognosis [6].