Pericardial tamponade

Occurs as a result of circulatory insufficiency associated with overwhelming infection Occurs when obstruction of blood flow results in inadequate tissue perfusion. Examples include a severe reduction of blood flow as the result of massive pulmonary embolism, pericardial tamponade, restrictive pericarditis, and severe cardiac valve dysfunction Occurs as a result of blockade of neurohum oral outflow. Examples include from a pharmacological source (ie, spinal anesthesia) or direct injury to the spinal cord. This type of shock is rare. 

Causes of diastolic dysfunction (restriction in ventricular filling) are increased ventricular stiffness, ventricular hypertrophy, infiltrative myocardial diseases, myocardial ischemia and infarction, mitral or tricuspid valve stenosis, and pericardial disease (e.g., pericarditis, pericardial tamponade). 

Patients with pericardial tamponade, restrictive cardiomyopathy, constrictive pericarditis, solutions containing dextrose in patients with known allergy to corn or corn products (IV). 

Contraindications Allergy to adhesives (transdermal), closed-angle glaucoma, constrictive pericarditis (IV), early MI (sublingual), GI hypermotility or malabsorption (extended-release), head trauma, hypotension (IV), inadequate cerebral circulation (IV), increased intracranial pressure (ICP), nitrates, orthostatic hypotension, pericardial tamponade (IV), severe anemia, uncorrected hypovolemia (IV)... 

When the heart can no longer pump an adequate supply of blood to meet the metabolic needs of the tissues or in relation to venous return, cardiac failure may ensue. The causes of cardiac failure are complex, but stem from mechanical abnormalities (e.g., pericardial tamponade), myocardial failure (e.g., cardiomyopathy and inflammation), and arrhythmias. In high-output failure, the cardiac output, which may be normal or even higher than normal, is not sufficient to meet the metabolic requirement of the body. Cardiac failure may predispose a patient to congestive heart failure, which is a state of circulatory congestion. Toxic injury, caused by agents such as doxorubicin, the alkaloid emetine in ipecac syrup, cocaine, or ethyl alcohol, is another way by which the functional integrity of the heart may also be compromised. 

Derk CT, Sandorfi N, Curtis MT. A case of anti-Jol myositis with pleural effusions and pericardial tamponade developing after exposure to a fermented Kombucha beverage. Clin Rheumatol 2004 23(4) 355-7. 

Eosinophilic pleural effusion with eosinophihc pericardial tamponade has been attributed to concomitant use of pantothenic acid and biotin (2). 

The more serious events include massive hemorrhage with shock, intracranial bleeding and stroke, and pericardial tamponade. Plasma warfarin levels are not routinely done. The effect of warfarin is best followed by the PT and International Normalized Ratio (INR). Under therapeutic conditions the INR is maintained at 2.0-3.0, except for prophylaxis after artificial heart valve replacement when it may be 2.0-3.5. Specific assays of factor activity can be measured although this is not usually necessary. 

Other less frequent complications of lead extraction include arteriovenous fistulas that present either acutely or in the days following the procedure. Pericardial tamponade could be clinically evident several hours after the procedure. Patients undergoing lead extraction should be monitored for at least 24 h in the intensive care unit, with echocardiography performed electively immediately after the procedure and 6 h later to evaluate the pericardial space and tricuspid valve integrity. Life-threatening arrhythmias such as ventricular tachycardia, torsade de pointes, and ventricular fibrillation are rare but possible complications. 

Dangerous comphcations like aortic rupture, pericardial tamponade, or hemothorax can be identified easily by CT. However, echocardiography or MRI is required in order to determine the function of the valves. 

Cardiovascular In a case report, a renal transplant patient treated with sirolimus developed pericardial tamponade associated with interstitial pnemnonia, proteinuria and microcytic anaemia. No other causes were found and all symptoms disappeared 1 month after sirolimus interruption [47 ]. 

Chose, M. K. (1975) Pericardial tamponade. A presenting manifestation of procainamide induced lupus erythematosus. Amer. J. Med., 58, 581. 

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