Management Strategies in Pericardial Emergencies

Abstract

Natural history of pericardial diseases can be complicated with pericardial emergencies requiring prompt diagnosis, intensive care with hemodynamic monitoring, and early aggressive management. Medical supportive measures, drainage of pericardial effusion, surgical pericardiotomy, and pericardiectomy should be applied when needed with no delay. This procedural approach also applies to iatrogenic interventions leading to tamponade.

Causes of moderate to large pericardial effusion requiring pericardiocentesis in 140 Han Chinese patients

“…Exudative pericardial effusion can be divided into malignant and nonmalignant types, and it is usually necessary to perform pericardiocentesis. Although tuberculosis is rare in developed countries, tuberculosis is still the major etiology of the nonmalignant type of pericardial effusion in China [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17].…”

“…The most important rescue procedure is pericardiocentesis. The therapy and prognosis of pericardial effusion are mainly dependent on the underlying diseases [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17]. While modern medicine has made great progress, there are still many patients with exudative pericardial effusion, in particular bloody pericardial effusion, who cannot be diagnosed early and correctly, which delays the required treatment.…”

Controversial Issues in the Management of Pericardial Diseases

“…[5][6][7] Emerging additional causes include iatrogenic origins (percutaneous coronary interventions, pacemaker insertion, catheter ablation). 14 These are contemporary examples of postcardiac injury syndromes in which the etiology is determined by a combination of direct pericardial trauma, pericardial bleeding, and individual predisposition. Tuberculous pericarditis may be found in North America and Western Europe, especially among immigrants from areas with a high prevalence of tuberculosis and HIV-infected patients.…”

Swallowed a Needle Stuck in Heart

“…[1] Dyspnea, chest pain, hypotension, tachycardia, pulsus paradoxus, raised jugular venous pressure, muffled heart sounds, decreased ECG voltage, and enlarged cardiac silhouette on chest X-ray are the major clinical signs in CT. [3] The percutaneous pericardiosynthesis, balloon pericardiotomy or surgical drainage are the treatment options depending on the clinical presentation. [3][4][5] Depending on the rate of effusion formation, CT can have rapid or slow progression. This situation shows that tamponade is related mostly to the rate of accumulation of fluid in the pericardium rather than the quantity of effusion.…”