Cases reported "Cardiac Tamponade"

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1/79. cardiac tamponade: an unusual, fatal complication of infective endocarditis.

    Infective endocarditis still occurs in Western countries and so far, it has been an important medical problem. The spectrum of infective endocarditis complications may be extremely wide. We report two unusual cases of infective endocarditis complicated with heart rupture and pericardial effusion. In one case, the infective process spread from the aortic valve developing a sinus of valsalva aneurysm with subsequent aortic perforation. The perforation reached the right auricular epicardial region with subsequent epicardial rupture and hemopericardium. In the other patient, an infective process of the aortic cusps induced the formation of multiple abscesses in the left ventricle and in the right atrium. An annular abscess of the tricuspid valve was found. From the right atrium, an infected fistula spread through the atrial wall and perforated the epicardial surface of the right auricle. Aside from the rare occurrence of these complications in patients affected with infective endocarditis, these cases are of clinical interest because they raise the problem of the need of greater sensitivity to the diagnosis of endocarditis and proper diagnostic approach.
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2/79. Delayed cardiac tamponade after pacemaker insertion.

    Cardiogenic shock is one of the most dramatic presentations in emergency medicine and requires rapid and accurate assessment, evaluation, and treatment. The cardiovascular disasters that present with shock include acute myocardial infarction with pump failure, aortic dissection, massive pulmonary emboli, and cardiac tamponade. We report a patient who presented to our Emergency Department (ED) in cardiogenic shock 10 days after insertion of a permanent cardiac pacemaker. The patient had developed pericardial tamponade secondary to the insertion. In reviewing the literature, we found many reports relating to complications of pacemakers and even more information regarding the various etiologies of cardiac tamponade, but cardiac tamponade as a consequence of pacemaker insertion rarely has been reported. cardiac tamponade can occur secondary to perforation of the right ventricle during pacemaker electrode insertion and manipulation. Perforation is generally believed to be benign and self-limiting and only rarely causes tamponade and hemodynamic compromise; however, that was not the case for our patient.
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3/79. cardiac tamponade following acupuncture.

    We present a rare complication of acupuncture in a 83-year-old woman who developed syncope and cardiogenic shock shortly after an acupuncture procedure into the sternum. echocardiography revealed cardiac tamponade, and pericardiocentesis disclosed hemopericardium. Due to hemodynamic instability, thoracotomy was indicated. A small but actively bleeding perforation of the right ventricle was found and successfully closed. Although acupuncture represents a relatively safe therapeutic intervention, this case report should remind all acupuncturists of possible and sometimes life-threatening adverse effects.
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4/79. Detection of iatrogenic cardiac tamponade by transesophageal echocardiography during vena cava filter procedure.

    PURPOSE: To present a patient who developed cardiac tamponade during insertion of an inferior vena cava (IVC) filter. Intraoperative transesophageal echocardiography (TEE) was used as a means to diagnose the cardiac tamponade and to facilitate guiding of pericardiocentesis. CLINICAL FEATURES: A 45-yr-old man with protein s deficiency complicated by repeated attacks of deep vein thrombosis and pulmonary thromboembolism was scheduled for insertion of an IVC filter. He had history of chronic renal insufficiency, heart failure, and cerebral infarction with mild left hemiparesis. Current medication included diltiazem (30 mg, I tab tid ), prednisolone (5 mg, 2 tabs qd ), and warfarin (2.5 mg daily). Preoperative transthoracic echocardiography demonstrated bilateral pleural effusions, moderate mitral regurgitation and tricuspid regurgitation, left atrial appendage thrombus and severe generalized hypokinesia of left ventricle. Nuclear medicine examination by (99)Tc showed ejection fractions of left ventricle and right ventricle as 20% and 22%, respectively. Under the impression of protein s deficiency with multiple attacks of thromboembolism and failure of anticoagulant therapy, he was arranged for the procedure of vena caval filter insertion. Unfortunately, iatrogenic cardiac tamponade occurred during the course of the procedure with rapid hemodynamic deterioration. Because of the expedient of routine monitoring of cardiac condition with TEE, a prompt diagnosis was made. We successfully improved the patient's hemodynamic status after transthoracic echo-guided pericardiocentesis. CONCLUSION: Intraoperative TEE is recommended to be used routinely in patients undergoing vena cava filter procedures. The availability of echocardiographic monitoring in the operation room allows the confirmation of the diagnosis and facilitation pericardiocentesis.
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keywords = ventricle, cerebral
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5/79. Post-traumatic left ventricular false aneurysm.

    Most false aneurysms of the heart represent contained ventricular free wall ruptures after myocardial infarction. Post-traumatic aneurysms also may follow penetrating or non-penetrating trauma to the chest. Regardless of the origin of the false aneurysm there is a propensity for aneurysm rupture. We report a patient who developed a false aneurysm of her left ventricle that developed post-motor vehicle accident. Her orthopedic problems were the clinical problems identified and after a hospital admission of 10 days she was discharged home. Four weeks later she died suddenly from anterior left ventricle false aneurysm rupture and tamponaide. patients with significant chest wall trauma should be assessed for cardiac pathology prior to discharge. Presentation may be delayed and be overshadowed by more evident pathology. Trauma-related aneurysms may cause sudden death, and this may occur some later time after the trauma. Attributing the cause of death to the trauma, which may be remote, is important for the forensic investigator to remember.
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6/79. Thrombus on the intraluminal felt strip. A possible cause of postoperative stroke.

    We report a case of a 60-year-old woman who received an operation for acute aortic dissection and who had a postoperative complication of multiple cerebral infarction. Through aggressive investigation using transesophageal echocardiography, a mobile thrombus on the intraluminal felt strip used for the enforcement of the dissecting aortic wall was detected as the possible source of the cerebral thromboembolism. After anticoagulation therapy was started, the mobile thrombus growing on the intraluminal felt strip disappeared, and no new lesions of cerebral thromboembolism occurred.
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keywords = cerebral
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7/79. Death due to accidentally self-inflicted gunshot wound.

    A 37-year-old man, with the entrance gunshot wound on the front of the right leg several cm above the knee, was found dead at home in his bed. No other lesions were observed except a contusion ring around the wound that spread downward and to the right. On autopsy, the wound path was followed upward from the entrance wound (0.7 cm in diameter). The bullet went through the medial aspect of the quadriceps and adductor muscles and continued upward, adjacently to the internal iliac artery, perforating the pelvic floor and the median lobe of the prostate. It passed by the left kidney, injuring its fatty capsule, then went through the mesentery near the left segment of the transverse and descending colon, and entered the thoracic cavity through the diaphragm, injuring the posterior wall of the pericardium and the posterior wall of the left ventricle at the level of the first left rib. The bullet was found in the apex of the left lung. Death was caused by cardiac tamponade.
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8/79. Anesthetic implications of subacute left ventricular rupture following acute myocardial infarction: a case report.

    Rupture of the free wall of the left ventricle, a relatively common complication of acute myocardial infarction, is associated with a high mortality rate. The clinical course can vary from catastrophic, that is death, to incomplete rupture with the formation of a pseudoaneurysm. Subacute rupture is a condition that demands expeditious diagnosis and surgical repair if the patient is to survive. Surgical repair can be difficult at best. This article reports a case of subacute rupture of the left ventricle that was successfully repaired using a novel surgical technique and discusses the anesthetic implications surrounding the case.
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9/79. Primary pericardial fibrosarcoma presenting as "near" cardiac tamponade.

    A 19-year-old male presented with fever, substernal pain, dyspnea, and distended neck veins. Diagnostic investigations, such as echocardiography and magnetic resonance imaging, provided evidence of a large mass within the pericardial sac, attached by a broad base to the parietal pericardium and lying along the right ventricular free wall. A partial pericardiectomy was performed to relieve the patient's symptoms, and histologic examination of a biopsy specimen showed features of a malignant, spindle cell, mesenchymal neoplasm. The patient underwent surgical treatment during which the tumor was found to infiltrate the anterior surface of the right ventricle. Histologically, the tumor was identified as a high-grade fibrosarcoma, and additional chemotherapy was given.
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10/79. ketamine anesthesia for pericardial window in a patient with pericardial tamponade and severe COPD.

    PURPOSE: To describe the use and concerns of ketamine anesthesia for pericardial window in a patient with pericardial tamponade and severe chronic obstructive pulmonary disease (COPD) with CO(2) retention. CLINICAL FEATURES: A 73-yr-old woman with long-standing COPD and cor pulmonale admitted with pericardial effusion and tamponade had surgery for a pericardial window receiving a total of ketamine 450 mg iv. Arterial pCO(2) increased from 71.8 mmHg preoperatively to 96 mmHg intraoperatively postdrainage of 1000 mL of effusion. Hemodynamic stability and SpO(2) >93% were maintained. intubation was avoided and concerns of increased pulmonary vascular resistance and potential for right ventricular failure in an already compromised right ventricle were not observed clinically. CONCLUSION: In this patient with pericardial tamponade, COPD and CO(2) retention, the advantages of ketamine included maintaining spontaneous ventilation, avoiding institution and weaning of mechanical ventilation, bronchodilation and relative preservation of the CO(2) response curve. Deleterious effects on right ventricular afterload were not observed.
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