Percutaneous BalloonPericardiotomy for Patients withPericardial Effusionand Tamponade Flashcards
What does an elevated RV pressure with exaggerated respiratory variation indicate?
Pericardial tamponade
Echocardiographic evidence of right ventricular collapse lasting more than one-third of diastole is a specific sign of cardiac tamponade.
Define pulsus paradoxus.
> 10-mm Hg drop in systolic arterial pressure during inspiration
It is an exaggeration of the normal respiratory variation in blood pressure.
What happens to the Y descent in pericardial tamponade due to high intrapericardial pressures?
Blunted Y descent
This corresponds to the tricuspid valve opening and right atrial emptying.
Which condition is a well-described cause of pulsus paradoxus?
Constrictive pericarditis
Pericardial tamponade may occur in the absence of pulsus paradoxus.
What is a common occurrence after percutaneous balloon pericardiotomy?
Left pleural effusion within 24 to 48 hours
Occurs in up to 50% of patients.
What is the recommended technique to confirm balloon position during percutaneous balloon pericardiotomy?
Biplane fluoroscopy
It is recommended to confirm the balloon’s position in two planes before inflation.
What are relative contraindications for percutaneous balloon pericardiotomy?
Platelet or coagulation abnormalities
Excessive bleeding may require surgical intervention.
What is the best hemodynamic parameter for distinguishing pericardial constriction from restrictive cardiomyopathy?
Dynamic respiratory variation
Right ventricular systolic pressure increases during inspiration while left ventricular systolic pressure decreases.
What major complications are reported in cases of pericardiocentesis?
1.3% to 1.6%
Drainage of more than 1 L of pericardial fluid may lead to right ventricular dilatation.
Which type of aortic dissection has the highest occurrence of tamponade?
DeBakey type II
Tamponade occurs in 18% to 45% of these cases.
What percentage of malignancy-related pericardial effusions are associated with lung and breast cancer?
Approximately 88% freedom from recurrence at 4 months
Percutaneous balloon pericardiotomy is highly successful in these cases.
What is the expected change in right and left atrial pressures during expiration in pericardial tamponade?
Both pressures fall
Right ventricular middiastolic pressures may equal the right atrial and pericardial pressures.
What is the mortality rate for untreated tuberculous pericarditis?
Up to 85%
Constrictive pericarditis occurs in 30% to 50% of patients with this condition.
What is the sensitivity and specificity of distinguishing constrictive pericarditis from restrictive cardiomyopathy?
> 90% sensitive and specific
The right and left ventricular end diastolic pressures usually differ by <5 mm Hg.
What is a major risk associated with endomyocardial biopsy?
Right ventricular perforation
Complication rates are between 0.3% to 5% of cases.
What is a pathognomonic sign of pericardial inflammation?
Pericardial friction rub
It is caused by contact between two layers of inflamed pericardium.
What should be included in the differential diagnosis of clinical syndrome consistent with right heart failure in a patient with prior malignancy?
- Pericardial metastasis
- Pulmonary embolism
- Chemotherapy-induced cardiomyotoxicity
Metastatic pericardial effusion evolves gradually and presents with fluid overload.
What genetic mutation is associated with TRAPS (tumor necrosis factor recurrent acute pericarditis syndrome)?
Mutations in the TNFRSF1A gene
Patients with TRAPS may have recurrent fever, skin rash, and polyserositis.
What percentage of patients may experience transient constrictive physiology that resolves completely with medical therapy?
A subset of patients
This was observed more often in patients developing constriction after cardiac surgery.
What are the approaches to pericardiocentesis?
- Subxiphoid
- Right xiphocostal
- Apical
- Parasternal
Echo-guided pericardiocentesis often favors the left chest wall approach.
What percentage of cases of percutaneous balloon pericardiotomy may require thoracocentesis?
Approximately 10% to 15%
Continuous drainage of >100 mL in 24 hours indicates the need for further intervention.
What is the incidence of pericardial effusion after coronary artery bypass surgery?
50%
This condition occurs commonly following the procedure.
What indicates the need for a more definitive percutaneous or surgical procedure after balloon pericardiotomy?
Continuous drainage of >100 mL in 24 hours, 3 days post-procedure, and reaccumulation of an effusion with tamponade.
A primary surgical approach may be preferred if a loculated fibrinous effusion is present.
What is the incidence of pericardial effusion after coronary artery bypass surgery?
50% to 85%
Cardiac tamponade occurs in approximately 1% to 2% of cases.
When does cardiac tamponade typically occur postoperatively?
More than a week postoperatively.
It is typically insidious in onset.
Does the use of NSAIDs reduce the size of pericardial effusion or the risk of tamponade?
No, evidence indicates that NSAIDs use neither reduces the size of the effusion nor reduces the risk of tamponade.
Reference: Meurin P, et al. Ann Intern Med 2010;152(3):137–143.
What is the incidence of cardiac perforation by an implanted lead of a cardiac implantable electronic device?
Less than 1%.
Late perforation is defined as perforation of the lead through the myocardium more than 1 month after implantation.
What are the common indicators of lead perforation?
Increase in lead impedance, failure to pace and sense, increase in pacing threshold.
Lead perforation is commonly associated with a pericardial effusion and is a recognized cause of pericardial tamponade.
What should be considered as causes for chest pain and hypotension following PCI?
Stent thrombosis, pericardial effusion, severe hemorrhagic shock.
Pleuritic pain is highly suspicious for pericardial irritation from pericardial effusion.
Why might TTE fail to detect localized effusion?
It often fails in the posterior location, behind the left atrium, and in the atrioventricular groove.
In high suspicion cases, a cardiac CT with contrast is recommended.
What characterizes pericardial fluid in patients with rheumatoid arthritis?
Low glucose concentration and elevated rheumatoid factor titer.
Pericardial involvement can be symptomatic or asymptomatic.
What is the most common cause of constrictive pericarditis in developing countries?
Tuberculosis.
Early treatment with antituberculous therapy and adjunctive steroids is recommended.
What can cause pericardial scarring associated with constrictive pericarditis?
Mediastinal radiotherapy for malignancies like esophageal cancer or lymphoma.
Systemic lupus erythematosus and other autoimmune conditions are rarely associated with extensive pericardial scarring.
