Unrecognized tamponade diagnosed pre-induction by focused echocardiography

Cardiac tamponade leading to the diagnosis of eosinophilic granulomatosis with polyangiitis (Churg−Strauss syndrome): a case report and review of the literature

“…We could find only nine cases of EGPA with cardiac tamponade ( EGPA is one of the causes of eosinophilic myocarditis. However, concomitant myocardial involvement was detected by echocardiography or myocardial scintigraphy in only four of ten EGPA cases with cardiac tamponade [1,2,4,9]. CMR, which has emerged as a primary tool for noninvasive assessment of myocardial inflammation in patients with myocarditis [10], did not show myocardial injury in the present case of EGPA even at the time of cardiac tamponade.…”

Focused ultrasound is the next step in perioperative care

“…2 In this case, the ultrasound examination revealed an unsuspected pericardial effusion. Ultrasound has been reported as a complementary tool during preoperative evaluation not only to assess cardiac function but also to detect pulmonary edema, identify a pleural effusion, examine the airway, 14 evaluate stomach content, 15 assess diaphragmatic motion, 16 and rule out deep vein thrombosis.…”

“…Point-of-care bedside ultrasound allows the identification of the mechanism(s) in question. The Table classifies the echocardiographic findings of the two case reports 1,2 according to the mechanisms involved. The first patient 1 initially presented with a decrease in mean systemic venous pressure indicative of distributive or hypovolemic shock due to hemorrhage.…”

“…1,2 These ultrasound observations led to a change in patient management, and it is expected that more widespread use of this tool in our practice will likely have a significant impact on perioperative care. This paradigm change implies that consideration should be given to incorporating an ultrasound curriculum within our anesthesiology training programs.…”

Pro: Focused Cardiac Ultrasound Should be an Integral Component of Anesthesiology Residency Training

“…Is my preoperative cardiac assessment complete?Gerlach et al (2013) described a patient presenting for elective endoscopic sinus surgery who underwent FCU preoperatively to determine volume status given his known diagnosis of aortic stenosis[18]. Unexpectedly, FCU revealed cardiac tamponade, which was not appreciated by physical examination.What is my patient's volume status?…”