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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Emergency surgery is required to prevent cardiac tamponade. The risks of surgery are great, with a perioperative mortality of more than 20%, but mortality risk increases with every hour from presentation.
A lorry driver with chest pain
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
This condition is a medical emergency. Cardiac tamponade occurs when fluid (either blood or a pericardial effusion) collects between the visceral and parietal pericardium. As the outer fibrous pericardium is relatively inelastic, the heart volume is compromised by the fluid collection within the pericardial cavity. The rising intrapericardial pressure gradually reduces ventricular filling, and thus cardiac output. Eventually mechanical pump failure and death ensue.
Trauma
Published in Anna Kowalewski, SBAs and EMQs in Surgery for Medical Students, 2021
Cardiac tamponade is an emergency. The pericardium should be drained as soon as possible. This is usually accomplished through pericardiocentesis unless other facilities for direct visualisation are available. If the patient is unstable, thoracotomy may be undertaken.
Acute purulent pericarditis treated conservatively with intrapericardial fibrinolysis and intrapericardial and systemic antibiotics
Published in Baylor University Medical Center Proceedings, 2021
Mahmoud Abdelnabi, Abdallah Almaghraby, Yehia Saleh, Alyaa El Sayed, Judy Rizk
Purulent pericarditis is typically present as an acute illness characterized by high-grade fever, tachycardia, cough, and less commonly chest pain. In the postoperative setting, most patients with purulent pericarditis also have signs of mediastinitis or sternal wound infection. Cardiac tamponade may also occur.3S. aureus is the most common implicated pathogen, while Streptococcus pneumoniae is the most common organism in the setting of direct extension of an intrathoracic infection. Other causes include gram-positive organisms, fungi, and Mycobacterium tuberculosis. Polymicrobial infections are uncommon.4–6 Pericardial fluid analysis including chemical testing (for protein and glucose content as well as white cell count), microscopy (gram stain, acid-fast stain, and fungal stain), and culture and sensitivity is the mainstay for the diagnosis of purulent pericarditis.7
Massive purulent pericarditis presenting as cardiac tamponade
Published in Baylor University Medical Center Proceedings, 2020
Azka Latif, Apurva D. Patel, Toufik Mahfood Haddad, Chetan Lokhande, Michael Del Core, Dennis Esterbrooks
Purulent pericarditis is mostly seen in immunocompromised patients. It carries a high mortality and morbidity, with a mortality rate reaching approximately 85% in untreated patients.4 Cardiac tamponade, which is seen in 42% to 77% of patients, can lead to rapid clinical deterioration via septic shock and hemodynamic compromise if left untreated.5,6 Tamponade is usually suspected if the patient has high jugular venous pressure with muffled heart sounds and hypotension (Beck’s triad). A chest radiograph with an enlarged cardiac silhouette is usually seen with large pericardial effusion. However, a rapidly accumulating smaller effusion can lead to tamponade without an enlarging cardiac silhouette, highlighting the importance of echocardiography in acute pericarditis.7
Active chest tube clearance after aortic valve surgery did not influence amount residual pericardial fluid after aortic valve replacement in a randomised trial
Published in Scandinavian Cardiovascular Journal, 2020
Linnéa Malgerud, Eva Maret, Christian Reitan, Torbjörn Ivert
The amount of blood present on echocardiography outside of the right atrium, right ventricle, posterior to the left ventricle and lateral to the left ventricle as measured in millimetres and the width of the inferior vena cava after aortic valve surgery did not differ between the two groups (Table 3). Thirty-eight patients (76%) in the PleuraFlow® group and 34 patients (68%) in the control group had 2 mm or more pericardial effusion (p = .50). A cumulative plot of our four measured sites of pericardial effusion indicate a similar number of patients in each of the groups had effusions in more than one location (Figure 3). Eight patients in PleuraFlow® group (16%) and 11 in the Argyle group (22%) had total ≥20 millimetres effusion (p = .61). The corresponding figures for ≥10 millimetres effusion were 38% and 44%, respectively (p = .68). Five of 14 patients in the Argyle group (36%) and 3 of 17 in the PleuraFlow® group (18%) with anticoagulation because of a mechanical valve had total pericardial effusion ≥10 mm (p = .41). Three patients were readmitted during the first postoperative month because of pericardial fluid, one in the PleuraFlow® group and two in the Argyle group. None of the patients showed clinical signs of late cardiac tamponade.