Cardiac tamponade in medical patients.

Guberman, B; Fowler, Noble O.; Engel, Peter J.; Gueron, M; Allen, J. M.

doi:10.1161/01.cir.64.3.633

Cited by 278 publications

(130 citation statements)

References 49 publications

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“…The majority of patients are diagnosed with hypothyroidism and commenced on levothyroxine replacement before a haemodynamically significant effusion can develop. 2 This case is one of only a handful of reported cases of tamponade due to secondary hypothyroidism in previously undiagnosed hypopituitarism Clinical signs of cardiac tamponade, such as tachycardia, pulsus paradoxus and jugular venous distension (which in association with muffled heart sounds and hypotension make up Beck's Triad), 3 are frequently absent in both primary and secondary hypothyroid patients. A small study of tamponade associated with primary hypothyroidism noted lower heart rates in the hypothyroid tamponade cases (80.75±13 beats/min) compared with euthyroid cases (112±12.8 beats/min, p<0.01), and suggested that hypothyroidism be considered in the differential of a patient with a significant pericardial effusion without a tachycardic response.…”

Section: Pericardial Effusion In Hypothyroidism and Hypopituitarismmentioning

confidence: 82%

Getting to the heart of hypopituitarism

et al. 2017

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A 53-year-old woman was diagnosed with hypopituitarism following an acute presentation with cardiac tamponade and hyponatraemia, having recently been investigated for a pericardial effusion. Secondary hypothyroidism is a rare cause of pericardial effusion and tamponade, but an important differential to consider. Management requires appropriate hormone replacement and, critically, a low threshold for commencing stress dose steroids. Clinical signs classically associated with cardiac tamponade are frequently absent in cases of tamponade due to primary and secondary hypothyroidism, and the relatively volume deplete state of secondary hypoadrenalism in hypopituitarism may further mask an evolving tamponade, as the rise in right atrial pressure is less marked even in the presence of large effusion. Our case demonstrates the importance of a high index of suspicion for cardiac tamponade in this patient cohort, even in the absence of clinical signs, and for measuring both thyroid-stimulating hormone and thyroxine levels when evaluating a pericardial effusion.

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Section: Pericardial Effusion In Hypothyroidism and Hypopituitarismmentioning

confidence: 82%

Getting to the heart of hypopituitarism

et al. 2017

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“…17 However, in another study, 98% of patients with pericardial tamponade had pulsus paradoxus. 18 This discrepancy may be explained by the fact that pulsus paradoxus is less likely to be seen in cardiac tamponade when certain comorbidities are present (eg, ventricular hypertrophy, heart failure, severe aortic regurgitation, large atrial septal defect, cardiac adhesions, severe hypotension, and acute left ventricular myocardial infarction). 11 These certain conditions mask the presence of pulsus paradoxus because they counteract the mechanisms responsible for pulsus paradoxus by either decreasing right-sided filling of the heart, increasing filling of the left atrium during diastole, or causing a more subtle shift of the interventricular septum.…”

Section: Sensitivity and Specificity Of Pulsus Paradoxusmentioning

confidence: 99%

Adolf Kussmaul: Distinguished Clinician and Medical Pioneer

Johnson¹,

Naidu²,

Ostopowicz³

et al. 2009

Clinical Medicine & Research

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“…Hemopericardium with cardiac tamponade is a lifethreatening situation that can occur in patients with myocardial infarction, aortic dissection, and malignant or infectious pericardial diseases [1]. In addition, both penetrating and non-penetrating chest trauma can be associated with hemorrhagic cardiac tamponade that generally occurs within several hours to a few days [2].…”

Section: Introductionmentioning

confidence: 99%