Posters
Presentation Type
Poster
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Background: Cardiac tamponade is a life-threatening condition, that results from progressive or acute accumulation of fluid in the pericardial space impairing cardiac hemodynamics. It is a rare complication of acute pericarditis. About two-thirds of acute pericarditis present with pericardial effusion. Of which, hemodynamic instability is seen in 3-5% of the cases. Point of Care Ultrasound is a cost-effective tool that aids in the prompt identification of life-threatening conditions such as tamponade.
Case presentation: 36-year-old male presented with complaints of fever and dyspnea on exertion for 4 days. He reported being tachycardic at home on his personal pulse oximeter. Past medical history was significant for asthma. Vital signs upon admission were T 101.5 F, HR 128 bpm, RR 20, BP 115/72mmHg SpO2 97% on room air. On the physical exam, there was no jugular venous distention, lungs and heart sounds were normal. There was inspiratory variation of systolic blood pressure more than 10 mmHg consistent with Pulsus paradoxus. Laboratory analysis showed WBC 15.83, Hb 15.4, Platelets 336, and negative troponin. Infectious work up including covid was negative. EKG showed sinus tachycardia, low voltage in precordial leads, PR segment depression in lead II, V5, V6 and PR segment elevation in AVR and V1. Point of care ultrasonography was done at the bedside which revealed a large pericardial effusion with diastolic collapse of the right ventricle. This was suggestive of cardiac tamponade prompting an emergency transfer for pericardiocentesis. Right heart catheterization revealed cardiac tamponade physiology and 1150 ml of pericardial fluid was removed. The patient was diagnosed with idiopathic pericarditis after further workup. He was started on colchicine and ibuprofen with clinical improvement, hence discharged with follow up.
Conclusion: Cardiac tamponade is a rare and life-threatening complication of acute pericarditis, associated with high morbidity and mortality. Cardiac tamponade might not always have the classical clinical presentation. Point of care ultrasound expedites the diagnosis of tamponade physiology in a safe and cost-effective manner. Thus, early detection of cardiac tamponade helps in life-saving emergent interventions in a resource limited setting. Front-line practitioners and training physicians may benefit from point-of-care ultrasound training strategies in their institutions.
Academic/Professional Position
Resident
Academic/Professional Position (Other)
PGY2
Mentor/PI Department
Internal Medicine
Recommended Citation
Zamudio Herrera, Oscar Rodrigo and Varghese, Nevin, "A swinging heart: Relevance of point of care ultrasound in the diagnosis of an atypical complication of acute pericarditis" (2023). Research Symposium. 84.
https://scholarworks.utrgv.edu/somrs/2022/posters/84
Included in
A swinging heart: Relevance of point of care ultrasound in the diagnosis of an atypical complication of acute pericarditis
Background: Cardiac tamponade is a life-threatening condition, that results from progressive or acute accumulation of fluid in the pericardial space impairing cardiac hemodynamics. It is a rare complication of acute pericarditis. About two-thirds of acute pericarditis present with pericardial effusion. Of which, hemodynamic instability is seen in 3-5% of the cases. Point of Care Ultrasound is a cost-effective tool that aids in the prompt identification of life-threatening conditions such as tamponade.
Case presentation: 36-year-old male presented with complaints of fever and dyspnea on exertion for 4 days. He reported being tachycardic at home on his personal pulse oximeter. Past medical history was significant for asthma. Vital signs upon admission were T 101.5 F, HR 128 bpm, RR 20, BP 115/72mmHg SpO2 97% on room air. On the physical exam, there was no jugular venous distention, lungs and heart sounds were normal. There was inspiratory variation of systolic blood pressure more than 10 mmHg consistent with Pulsus paradoxus. Laboratory analysis showed WBC 15.83, Hb 15.4, Platelets 336, and negative troponin. Infectious work up including covid was negative. EKG showed sinus tachycardia, low voltage in precordial leads, PR segment depression in lead II, V5, V6 and PR segment elevation in AVR and V1. Point of care ultrasonography was done at the bedside which revealed a large pericardial effusion with diastolic collapse of the right ventricle. This was suggestive of cardiac tamponade prompting an emergency transfer for pericardiocentesis. Right heart catheterization revealed cardiac tamponade physiology and 1150 ml of pericardial fluid was removed. The patient was diagnosed with idiopathic pericarditis after further workup. He was started on colchicine and ibuprofen with clinical improvement, hence discharged with follow up.
Conclusion: Cardiac tamponade is a rare and life-threatening complication of acute pericarditis, associated with high morbidity and mortality. Cardiac tamponade might not always have the classical clinical presentation. Point of care ultrasound expedites the diagnosis of tamponade physiology in a safe and cost-effective manner. Thus, early detection of cardiac tamponade helps in life-saving emergent interventions in a resource limited setting. Front-line practitioners and training physicians may benefit from point-of-care ultrasound training strategies in their institutions.