Pericardial tamponade, a diagnostic chameleon: from the historical perspectives to contemporary management
Abstract Background Pericardial tamponade (PT) early after cardiac surgery is a challenging clinical entity, not infrequently misrecognized and often only detected late in its course. Because the clinical signs of pericardial tamponade can be very unspecific, a high degree of initial suspicion is re...
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-02-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-023-02174-9 |
| _version_ | 1811171596191137792 |
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| author | Ann-Sophie Kaemmerer Khaleel Alkhalaileh Mathieu N. Suleiman Markus Kopp Christine Hauer Matthias S. May Michael Uder Michael Weyand Frank Harig |
| author_facet | Ann-Sophie Kaemmerer Khaleel Alkhalaileh Mathieu N. Suleiman Markus Kopp Christine Hauer Matthias S. May Michael Uder Michael Weyand Frank Harig |
| author_sort | Ann-Sophie Kaemmerer |
| collection | DOAJ |
| description | Abstract Background Pericardial tamponade (PT) early after cardiac surgery is a challenging clinical entity, not infrequently misrecognized and often only detected late in its course. Because the clinical signs of pericardial tamponade can be very unspecific, a high degree of initial suspicion is required to establish the diagnosis. In addition to clinical examination the deployment of imaging techniques is almost always mandatory in order to avoid delays in diagnosis and to initiate any necessary interventions, such as pericardiocentesis or direct cardiac surgical interventions. After a brief overview of how knowledge of PT has developed throughout history, we report on an atypical life-threatening cardiac tamponade after cardiac surgery. A 74-year-old woman was admitted for elective biological aortic valve replacement and aorto-coronary-bypass grafting (left internal mammary artery to left anterior descending artery, single vein graft to right coronary artery). On the 10th postoperative day, the patient unexpectedly deteriorated. She rapidly developed epigastric pain radiating to the left upper abdomen, and features of low peripheral perfusion and shock. There were no clear signs of pericardial tamponade either clinically or echocardiographically. Therefore, for further differential diagnosis, a contrast-enhanced computed tomography scan was performed under clinical suspicion of acute abdomen. Unexpectedly, active bleeding distally from the right coronary anastomosis was revealed. While the patient was prepared for operative revision, she needed cardiopulmonary resuscitation, which was successful. Intraoperatively, the source of bleeding was located and surgically relieved. The subsequent postoperative course was uneventful. Conclusions In the first days after cardiac surgery, the occurrence of life-threatening situations, such as cardiac tamponade, must be expected. Especially if the symptoms are atypical, the entire diagnostic armamentarium must be applied to identify the origin of the complaints, which may be cardiac, but also non-cardiac. Central message A high level of suspicion, immediate diagnostic confirmation, and rapid treatment are required to recognize and successfully treat such an emergency (Fig. 5). Perspective Pericardial tamponade should always be considered as a complication of cardiac surgery, even when symptoms are atypical. The full range of diagnostic tools must be used to identify the origin of the complaints, which may be cardiac, but also non-cardiac (Fig. 5). |
| first_indexed | 2024-04-10T17:16:43Z |
| format | Article |
| id | doaj.art-e9a32aadab2249289d4a547b218c6b86 |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-04-10T17:16:43Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-e9a32aadab2249289d4a547b218c6b862023-02-05T12:23:27ZengBMCJournal of Cardiothoracic Surgery1749-80902023-02-011811910.1186/s13019-023-02174-9Pericardial tamponade, a diagnostic chameleon: from the historical perspectives to contemporary managementAnn-Sophie Kaemmerer0Khaleel Alkhalaileh1Mathieu N. Suleiman2Markus Kopp3Christine Hauer4Matthias S. May5Michael Uder6Michael Weyand7Frank Harig8Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-NürnbergDepartment of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-NürnbergDepartment of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-NürnbergInstitute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-NürnbergInstitute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-NürnbergInstitute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-NürnbergInstitute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-NürnbergDepartment of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-NürnbergDepartment of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-NürnbergAbstract Background Pericardial tamponade (PT) early after cardiac surgery is a challenging clinical entity, not infrequently misrecognized and often only detected late in its course. Because the clinical signs of pericardial tamponade can be very unspecific, a high degree of initial suspicion is required to establish the diagnosis. In addition to clinical examination the deployment of imaging techniques is almost always mandatory in order to avoid delays in diagnosis and to initiate any necessary interventions, such as pericardiocentesis or direct cardiac surgical interventions. After a brief overview of how knowledge of PT has developed throughout history, we report on an atypical life-threatening cardiac tamponade after cardiac surgery. A 74-year-old woman was admitted for elective biological aortic valve replacement and aorto-coronary-bypass grafting (left internal mammary artery to left anterior descending artery, single vein graft to right coronary artery). On the 10th postoperative day, the patient unexpectedly deteriorated. She rapidly developed epigastric pain radiating to the left upper abdomen, and features of low peripheral perfusion and shock. There were no clear signs of pericardial tamponade either clinically or echocardiographically. Therefore, for further differential diagnosis, a contrast-enhanced computed tomography scan was performed under clinical suspicion of acute abdomen. Unexpectedly, active bleeding distally from the right coronary anastomosis was revealed. While the patient was prepared for operative revision, she needed cardiopulmonary resuscitation, which was successful. Intraoperatively, the source of bleeding was located and surgically relieved. The subsequent postoperative course was uneventful. Conclusions In the first days after cardiac surgery, the occurrence of life-threatening situations, such as cardiac tamponade, must be expected. Especially if the symptoms are atypical, the entire diagnostic armamentarium must be applied to identify the origin of the complaints, which may be cardiac, but also non-cardiac. Central message A high level of suspicion, immediate diagnostic confirmation, and rapid treatment are required to recognize and successfully treat such an emergency (Fig. 5). Perspective Pericardial tamponade should always be considered as a complication of cardiac surgery, even when symptoms are atypical. The full range of diagnostic tools must be used to identify the origin of the complaints, which may be cardiac, but also non-cardiac (Fig. 5).https://doi.org/10.1186/s13019-023-02174-9Cardiac tamponadePostoperative complicationPericardial effusionDiagnosticsHistorical aspects |
| spellingShingle | Ann-Sophie Kaemmerer Khaleel Alkhalaileh Mathieu N. Suleiman Markus Kopp Christine Hauer Matthias S. May Michael Uder Michael Weyand Frank Harig Pericardial tamponade, a diagnostic chameleon: from the historical perspectives to contemporary management Journal of Cardiothoracic Surgery Cardiac tamponade Postoperative complication Pericardial effusion Diagnostics Historical aspects |
| title | Pericardial tamponade, a diagnostic chameleon: from the historical perspectives to contemporary management |
| title_full | Pericardial tamponade, a diagnostic chameleon: from the historical perspectives to contemporary management |
| title_fullStr | Pericardial tamponade, a diagnostic chameleon: from the historical perspectives to contemporary management |
| title_full_unstemmed | Pericardial tamponade, a diagnostic chameleon: from the historical perspectives to contemporary management |
| title_short | Pericardial tamponade, a diagnostic chameleon: from the historical perspectives to contemporary management |
| title_sort | pericardial tamponade a diagnostic chameleon from the historical perspectives to contemporary management |
| topic | Cardiac tamponade Postoperative complication Pericardial effusion Diagnostics Historical aspects |
| url | https://doi.org/10.1186/s13019-023-02174-9 |
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