1/980. Pericardial heart disease: a study of its causes, consequences, and morphologic features. This report reviews morphologic aspects of pericardial heart disease. A morphologic classification for this condition is presented. An ideal classification of pericardial heart disease obviously would take into account clinical, etiologic and morphologic features of this condition but a single classification combining these three components is lacking. Pericardial heart disease is relatively uncommon clinically, and when present at necropsy it usually had not been recognized during life. The term "pericarditis" is inaccurate because most pericardial diseases are noninflammatory in nature. Morphologically chronic pericardial heart disease may present clinically as an acute illness. Even when clinical symptoms are present, however, few patients develop evidence of cardiac dysfunction (constriction). When pericardial constriction occurs, it is the result of increased pericardial fluid or increased pericardial tissue or both. Increased fluid is treated by drainage; increased tissue is treated by excision. In most patients with chronic constrictive pericarditis the etiology is not apparent even after histologic examination of pericardia. ( info) |
2/980. Left ventricular apical diastolic collapse: an unusual echocardiographic marker of postoperative cardiac tamponade. A 37-year-old woman was evaluated for signs and symptoms of cardiac tamponade 11 days after mitral valve replacement and tricuspid valve repair. The transthoracic echocardiogram showed a large, compartmentalized pericardial effusion that resulted in left ventricular apical diastolic collapse. Also noted were right ventricular posterior wall diastolic collapse and hemodynamic findings consistent with cardiac tamponade. This case highlights the atypical echocardiographic findings in patients with pericardial effusions after cardiac surgery. ( info) |
3/980. Primary pericardial mesothelioma with cardiac tamponade and distant metastasis: case report. Although cardiac tamponade is a well-known complication of malignancy, it is uncommon as the initial manifestation. The antemortem diagnosis is difficult and distant metastasis is extremely rare. The presentations of primary pericardial mesothelioma are nonspecific. Pathologically, mesothelioma is the most common in primary tumors of the pericardium. Radical surgery can be used to treat a localized mesothelioma. However, the therapy for advanced primary pericardial mesothelioma is usually palliative because it is resistant to irradiation, and chemotherapy does not markedly improve the outcome. The prognosis is uniformly poor. The median survival from the onset of symptoms is 6 months. We present a 67-year-old woman with cardiac tamponade 4 months prior to a definitive diagnosis of primary pericardial mesothelioma. A computed tomogram confirmed multiple well-enhanced nodules in the pericardium, lungs and liver. Unfortunately, the patient died of multiple organ failure. ( info) |
| A 35-year-old woman presented with dyspnea and chest pain. She had a large aneurysm of the non-coronary sinus of valsalva. Before her scheduled urgent surgery, the patient collapsed and died of cardiac tamponade secondary to intrapericardial rupture of the aneurysm. We would advocate urgent repair of this type of lesion to prevent such an outcome. We are aware of no other specific reports addressing extracardiac rupture of non-coronary cusp aneurysms [corrected]. ( info) |
5/980. Long-term survival of a patient with left ventricular free wall rupture without surgical repair. This report describes the case of a patient who developed postinfarction left ventricular free wall rupture and cardiac tamponade. He was managed conservatively, made a successful recovery, and is alive and asymptomatic 10 months after the index episode. Only 17 cases in which the patients survived subacute rupture of the ventricular free wall over the long term without surgical repair have been reported in the literature. ( info) |
6/980. Atrial tamponade causing acute ischemic hepatic injury after cardiac surgery. A patient developed late cardiac tamponade after aortic valve replacement and coronary artery bypass grafting. nausea and dramatic elevations of serum aminotransferases were the initial clinical manifestations of cardiac tamponade. Severe acute ischemic hepatic injury secondary to isolated compression of both atrial cavities by two loculated thrombi was diagnosed. ( info) |
| Neoplastic involvement of the pericardium resulting in an effusion and subsequent tamponade is an emergency requiring prompt decompression, generally safely accomplished by subxiphoid pericardiectomy. However, the current case report describes a patient with florid pericardial tamponade who underwent surgical decompression with transient hemodynamic improvement, who then rapidly developed progressive, heart failure and death. This paradoxical response to pericardial decompression, similar to that seen occasionally with pericardiectomy in constrictive pericarditis, may be more frequent than currently appreciated. Its cause may relate to the sudden removal of the chronic external ventricular support from the effusion resulting in ventricular dilatation and failure. ( info) |
8/980. Subacute left ventricular free-wall rupture in early course of acute myocardial infarction. Clinical report of two cases and review of the literature. Left ventricular free wall rupture (LVFWR) may complicate an acute myocardial infarction (AMI); its frequency ranges from 1 to 6 percent. In the era of coronary care units, LVFWR is the second cause of in-hospital death, after pump failure. The subacute presentation accounts for 2-3 percent of total hospital admissions for AMI. heart rupture may not be suddenly fatal and sometimes there is enough time for surgical repair. Electromechanical dissociation is neither the only nor the main clinical presentation. More subtle symptoms occurring hours or days before the final event include unexplained hypotension and transient bradycardia and some ECG features such as persistent ST-segment elevation with T-waves failing to invert in the same leads. On echocardiographic subcostal view, pericardial effusion of more than 5-10 mm, with echo-dense masses overlying the heart independently of cardiac tamponade, is highly suggestive of heart rupture. If pericardiocentesis yields hemorrhagic fluid, surgical intervention is mandatory, providing both diagnostic confirmation and definitive treatment. Medical management strategies (prolonged bed rest, beta-blockade therapy) are still experimental but could become suitable for particular subsets of patients (elderly patients and patients at a high surgical risk). We report two cases of subacute LVFWR and review the currently available literature. ( info) |
| This report describes the case of a young woman who presented to an emergency department with severe abdominal pain and shock. The patient was found to have pericardial tamponade due to a massive pericardial effusion. On further evaluation, the etiology of this effusion was considered to be secondary to hypothyroidism with concominant acute viral pericarditis leading to a fulminant tamponade. The presentation, differential diagnosis, and management of pericardial effusion and tamponade secondary to hypothyroidism and viral pericarditis are discussed. The diagnosis of hypothyroidism in conjunction with acute viral pericarditis should be considered in patients presenting with unexplained pericardial effusion and tamponade. ( info) |
10/980. Hemopericardium, anticoagulation, and an endocardial pacemaker. A case report with description of new auscultatory and radiographic signs. A case of organizing hemopericardium and cardiac tamponade in a patient with a permanent endocardial pacemaker who was maintained on anticoagulation is presented. The hemopericardium is concluded as solely due to the anticoagulation. A new auscultatory finding attributable to an endocardial pacemaker and a helpful radiographic sign of pericardial effusion in patients with these pacemakers is described. ( info) |