Cardiac tamponade

Suggested Alternatives for Differential Diagnosis Hepatitis, Legionnaires disease, myocarditis, pericarditis, cardiac tamponade, pneumonia, ehrlichiosis, relapsing fever, Rocky Mountain spotted fever, and tularemia. 

SuccessM treatment of PEA and asystole depends almost entirely on diagnosis of the underlying cause. Potentially reversible causes include (1) hypovolemia, (2) hypoxia, (3) preexisting acidosis, (4) hyperkalemia, (5) hypothermia, (6) hypoglycemia, (7) drug overdose, (8) cardiac tamponade, (9) tension pneumothorax, (10) coronary thrombosis, (11) pulmonary thrombosis, and (12) trauma. 

When the cardiac electrical activity is maintained, but there is no mechanical output (pulseless electrical activity, electromechanical dissociation), then hypovolaemia, tension pneumothorax, pulmonary embolism, cardiac tamponade, and various forms of metabolic or pharmacological disturbance may be responsible. In asystole or pulseless electrical activity (with an underlying rate of less than 60 beats per minute) a single intravenous bolus of 3 mg atropine is recommended. 

The most serious complication of pericarditis is cardiac tamponade which is manifested by shortness of breath and hypotension. Emergency pericardiocentesis is required. In most cases, the frequency and duration of dialysis should be increased after pericarditis develops. Pericarditis is an absolute indication for beginning haemodialysis if the patient has not been previously dialyzed. Indomethacin may be used in patients with chest pain, although its value has not been substantiated by placebo-controlled studies. 

Extensive aortic dissection with cardiac tamponade and mesenteric ischemia has been attributed to ecstasy (27). 

Jessurun GAJ, Crijns HJGM, van Wijngaarden J. 1996. An unusual case of cardiac tamponade following electrical cardioversion. Int J Cardiol 53 317-320. 

A 45-year-old man developed acute cardiac tamponade due to systemic lupus erythematosus associated with carbamazepine, which he had taken for 8 months (70). 

Verma SP, Yunis N, Lekos A, Crausman RS. Carbamazepine-induced systemic lupus erythematosus presenting as cardiac tamponade. Chest 2000 117(2) 597-8. 

Cardiac glycosides are contraindicated in conditions in which there is obstruction to ventricular outflow, for example hypertrophic obstructive cardiomyopathy, constrictive pericarditis, and cardiac tamponade. Acute myocarditis may also increase the risk of toxicity. 

Gluszek S, Kot M, Matykiewicz J. Cardiac tamponade as a comphcation of catheterization of the subclavian vein— prevention and principles of management. Nutrition 1999 15(7-8) 580-2. 

A systematic review of case reports from the Japanese literature yielded 105 cases of suspected acupuncture adverse effects not previously reported in Western publications (66). These included 21 spinal lesions, 21 cases of pneumothorax, 19 infections, 15 cases of foreign bodies in organs, 10 instances of argyria, 10 neural injuries, and 11 other adverse events, including two cases of cardiac tamponade. 

An 83-year-old Austrian woman developed syncope and cardiogenic shock shortly after acupuncture over the sternum. Echocardiography showed cardiac tamponade and pericardiocentesis revealed hemopericardium. At operation a small bleeding perforation of the right ventricle was found and closed. The acupuncture at the point Ren 17 was above a sternal foramen, which allowed the needle to penetrate the heart. 

If acupuncture, which entails tissue trauma, is performed properly and on the correct acupuncture points, trauma will affect only the skin and the connective tissue below. If, however, acupuncture needles are inserted at the wrong site or penetrate too deeply, other tissues or organs can be affected. Traumatic complications of acupuncture have been reviewed (108). They have been described in relation to the thoracic and abdominal viscera, in the peripheral and central nervous systems, and in blood vessels. Several deaths have been reported from pneumothorax and cardiac tamponade. The anatomical tissues at several acupuncture points are such that needles can injure vulnerable structures. Thus, good knowledge of anatomy is an essential precondition for acupuncturists. 

A review of serious complications included one case of cardiac tamponade (with full recovery of the patient after surgery), one case of peripheral nerve damage (foot drop with residual weakness after 6 years), and three cases of pneumothorax (all with full recovery) (90). 

Kirchgatterer A, Schwarz CD, Holler E, Pnnzengrnber C, Hartl P, Eber B. Cardiac tamponade followmg acnpnnc-tme. Chest 2000 117(5) 1510-11. 

Hasegawa J, Noguchi N, Yamasaki J, Kotake H, Mashiba H, Sasaki S, Mori T. Delayed cardiac tamponade and hemothorax induced by an acupuncture needle. Cardiology 1991 78(l) 58-63. 

A woman developed peripheral eosinophiha and pericarditis with cardiac tamponade after using cromoglicate (SEDA-4, 120). Cellular and humoral sensitivity to cromoglicate were demonstrated and she recovered following pericardiocentesis. 

Copper deficiency has been reported in a patient with Crohn s disease after removal of copper from the parenteral nutrition because of severe cholestasis (59). The patient developed pancytopenia with severely depressed serum copper concentrations after 8 weeks. Bone-marrow biopsy confirmed the cause as copper deficiency. Although intravenous replacement of copper improved the patient s anemia and other markers, he suddenly died of cardiac tamponade. 

Mohindra SK, Udeani GO, Abrahamson D. Cardiac tamponade associated with drug-induced systemic lupus erythematosus. Crit Care Med 1989 17(9) 961-2. 

Both paditaxel and docetaxel may result in anaphylactoid or severe hypersensitivity reactions manifested by dyspnea, bronchospasm, angioedema, hypotension (occasionally HTN), and urticarial skin reactions. The reaction may be due to the active drug itself or to the vehicle (Cremophor or polysorbate 80). Additionally, patients receiving docetaxel may experience serious or life-threatening fluid retention. This syndrome is characterized by poorly tolerated peripheral or generalized edema, pleural effusion, dyspnea, ascites, and cardiac tamponade. 

Cardiac tamponade History (trauma, renal failure, thoracic malignancy), no pulse with CPR, vein distention, impending tamponade-tachycardia, hypotension, low pulse pressure changing to sudden bradycardia as terminal event Pericardiocentesis... 

In a worldwide survey of AF ablation, major complications were reported in 6% of patients, including cardiac tamponade in 1.2%, stroke in 0.28% and transient ischemic attacks in 0.66% of left sided procedures (164). Periprocedural mortality was reported in 0.05%, Most thromboembolic strokes occur within two weeks of the ablation procedure (165). To reduce the risk of stroke, anticoagulation is often instituted prior to ablation, particularly in patients with CHADS-II risk factors (congestive heart failure or left ventricular dysfunction, hypertension,... 

The client with pericarditis should avoid taking aspirin and anticoagulants because they may increase the possibility of cardiac tamponade. 

Fixation mechanism Active fixation leads seem to have advantages and disadvantages. On the one hand, once the screw is retracted, the tip can be easily detached from the endocardium, and the lead, being isodiametric, can be removed more easily than the others [6, 7]. On the other hand, an unscrewed lead is more difficult than a tined one. Fixation mechanisms that cannot be unscrewed, such as the Vitatron Helifix, make the procedure more complex, increasing the risks of myocardial perforation and cardiac tamponade. 

---