Abstract

Case Report

Cardiac Tamponade as the Cause of Pulmonary Edema: Case Report

Emídio Lima*

Published: 17 August, 2023 | Volume 7 - Issue 2 | Pages: 021-023

Introduction: Cardiac tamponade is an emergency syndrome that requires fast diagnosis and treatment; otherwise patient follows obstructive shock and cardiac arrest. 
Case report: A 70-year-old female was brought to the emergency department with hypoxemia. She had a history of progressive dyspnea over the past three weeks. Past medical history includes smoking. On physical examination: tachypnea, hypoxemia (SaO2 89%), jugular venous distention, arterial pressure 220/100 mmHg, heart rate rhythmic of 82 bpm. On pulmonary auscultation: diffuse and bilateral crackles. Lung ultrasound showed a bilateral B line and the echocardiogram demonstrated a pericardial effusion with signs of tamponade. A pericardiocentesis evacuated 620 ml of hemorrhagic fluid and the patient was transferred to the intensive care unit, hemodynamically stable, with SaO2 95%. At the ICU the echocardiogram, showed resolution of the cardiac tamponade and a tumor adhered to the lateral wall of the left ventricle. Chest CT demonstrated: a left lung tumor, infiltrating the pericardial sac. A pericardium biopsy demonstrated undifferentiated carcinoma. 
Discussion: Cardiac tamponade diagnosis requires a high level of suspicion. Respiratory failure, chest pain, and shock, observed in cardiac tamponade, are also present in different diseases. The most common finding of cardiac tamponade is dyspnea (78% of cases). Our patient had dyspnea due to pulmonary edema, secondary to left ventricle diastolic dysfunction caused by the tamponade. A bedside echocardiogram made the diagnosis of cardiac tamponade and guided the effective pericardiocentesis. 
Conclusion: Cardiac tamponade must be suspected in all cases of acute dyspnea. Echocardiogram is the method of choice for the diagnosis and for guiding the pericardiocentesis.

Read Full Article HTML DOI: 10.29328/journal.jprr.1001046 Cite this Article Read Full Article PDF

Keywords:

Cardiac tamponade; Bedside echocardiogram; Point of care ultrasound; Pericardiocentesis; Lung ultrasound

References

  1. Demetriades D. Cardiac wounds. Experience with 70 patients. Ann Surg. 1986 Mar;203(3):315-7. doi: 10.1097/00000658-198603000-00018. PMID: 3954485; PMCID: PMC1251098.
  2. Scheinin SA, Sosa-Herrera J. Case report: cardiac tamponade resembling an acute myocardial infarction as the initial manifestation of metastatic pericardial adenocarcinoma. Methodist Debakey Cardiovasc J. 2014 Apr-Jun;10(2):124-8. doi: 10.14797/mdcj-10-2-124. PMID: 25114766; PMCID: PMC4117332.
  3. Yarlagadda C. Cardiac tamponade: practice, essentials, background and pathophysiology. http://emedicine.medscape.com/article/152083- overview#showall
  4. Stashko E, Meer JM. Cardiac Tamponade. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK431090/.
  5. Martins QC, Juliano C. Pericardial Effusion and Cardiac Tamponade: Etiology and Evolution in the Contemporary Era. Int J Cardiovasc Sci. 25/out/2021. 34(5 supl 1) 24-31.
  6. Bottinor W, Fronk D, Sadruddin S, Foster H, Patel N, Prinz A, Jovin IS. Acute Cardiac Tamponade in a 58-Year-Old Male with Poststreptococcal Glomerulonephritis. Methodist Debakey Cardiovasc J. 2016 Sep;12(3):175-176. doi: 10.14797/mdcj-12-3-175. PMID: 27826373; PMCID: PMC5098576.
  7. Chong HH, Plotnick GD. Pericardial effusion and tamponade: evaluation, imaging modalities, and management. Compr Ther. 1995 Jul;21(7):378-85. PMID: 7554815.
  8. Lima E. Cardiac Tamponade as Cause of Respiratory Distress and Cardiac Arrest. J.Clin Case Stu. 2018; 3(3): dx.doi.org/10.16966/24714925.174
  9. Petcu DP, Petcu C, Popescu CF, Bătăiosu C, Alexandru D. Clinical and cytological correlations in pericardial effusions with cardiac tamponade. Rom J Morphol Embryol. 2009;50(2):251-6. PMID: 19434319.
  10. Cornily JC, Pennec PY, Castellant P, Bezon E, Le Gal G, Gilard M, Jobic Y, Boschat J, Blanc JJ. Cardiac tamponade in medical patients: a 10-year follow-up survey. Cardiology. 2008;111(3):197-201. doi: 10.1159/000121604. Epub 2008 Apr 25. PMID: 18434725.
  11. Barra LD. Acute cardiac tamponade: a brief review. Medical Journal of Minas Gerais. 2008; 18(3 supl 4): S37-S40.

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?