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Hemopericardium and cardiac tamponade in a patient with an elevated international normalized ratio.

Levis JT, Delgado MC - West J Emerg Med (2009)

Bottom Line: This case report describes a 54-year-old male on warfarin for atrial fibrillation who presented to the emergency department (ED) following a syncopal episode with persistent hypotension.The patient's International Normalized Ratio (INR) returned elevated at 6.0, and a rapid bedside cardiac ultrasound revealed a large pericardial effusion consistent with cardiac tamponade.The anticoagulation was reversed and the patient underwent successful pericardiocentesis with removal of 1,100 mL of blood.

View Article: PubMed Central - PubMed

Affiliation: Kaiser Santa Clara Medical Center, Department of Emergency Medicine, Santa Clara, CA.

ABSTRACT
This case report describes a 54-year-old male on warfarin for atrial fibrillation who presented to the emergency department (ED) following a syncopal episode with persistent hypotension. The patient's International Normalized Ratio (INR) returned elevated at 6.0, and a rapid bedside cardiac ultrasound revealed a large pericardial effusion consistent with cardiac tamponade. The anticoagulation was reversed and the patient underwent successful pericardiocentesis with removal of 1,100 mL of blood.

No MeSH data available.


Related in: MedlinePlus

12-lead ECG from a 54-year-old male with syncope and hypotension.
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f1-wjem-10-115: 12-lead ECG from a 54-year-old male with syncope and hypotension.

Mentions: On physical examination, the patient appeared well-hydrated, awake and alert and in no acute distress. Vital signs revealed an oral temperature of 97.9° F, a pulse of 92 beats per minute, a blood pressure of 100/60 mm Hg, and respirations of 22 breaths per minute with an oxygen saturation of 97% on room air. Jugular venous distension was noted on neck examination. Examination of the chest did not reveal ecchymosis or evidence of trauma. The lungs were clear to auscultation, and cardiac exam revealed distant heart sounds. Peripheral pulses were palpable but weak. A peripheral intravenous line was placed and blood was sent for laboratory testing, which was significant for a creatinine of 2.1 mg/dL (normal range <1.3), lactic acid 2.7 mmol/L (normal range 0.7–2.1), hematocrit 36%, and INR 6.0 (therapeutic range 2.0–3.0). A 12-lead ECG demonstrated low-voltage most prominent in leads I, II, III, aVL, aVF, and V1 (Figure 1). A portable chest radiograph was remarkable for cardiomegaly (Figure 2, panel A), compared to a portable chest radiograph obtained from the same patient four months earlier during an ED evaluation for chest pain (Figure 2, panel B). The emergency physician (EP) performed a bedside cardiac ultrasound, which revealed a large pericardial effusion (Figure 3; echo-free space >20 mm, corresponding to >700 mL effusion).


Hemopericardium and cardiac tamponade in a patient with an elevated international normalized ratio.

Levis JT, Delgado MC - West J Emerg Med (2009)

12-lead ECG from a 54-year-old male with syncope and hypotension.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2691517&req=5

f1-wjem-10-115: 12-lead ECG from a 54-year-old male with syncope and hypotension.
Mentions: On physical examination, the patient appeared well-hydrated, awake and alert and in no acute distress. Vital signs revealed an oral temperature of 97.9° F, a pulse of 92 beats per minute, a blood pressure of 100/60 mm Hg, and respirations of 22 breaths per minute with an oxygen saturation of 97% on room air. Jugular venous distension was noted on neck examination. Examination of the chest did not reveal ecchymosis or evidence of trauma. The lungs were clear to auscultation, and cardiac exam revealed distant heart sounds. Peripheral pulses were palpable but weak. A peripheral intravenous line was placed and blood was sent for laboratory testing, which was significant for a creatinine of 2.1 mg/dL (normal range <1.3), lactic acid 2.7 mmol/L (normal range 0.7–2.1), hematocrit 36%, and INR 6.0 (therapeutic range 2.0–3.0). A 12-lead ECG demonstrated low-voltage most prominent in leads I, II, III, aVL, aVF, and V1 (Figure 1). A portable chest radiograph was remarkable for cardiomegaly (Figure 2, panel A), compared to a portable chest radiograph obtained from the same patient four months earlier during an ED evaluation for chest pain (Figure 2, panel B). The emergency physician (EP) performed a bedside cardiac ultrasound, which revealed a large pericardial effusion (Figure 3; echo-free space >20 mm, corresponding to >700 mL effusion).

Bottom Line: This case report describes a 54-year-old male on warfarin for atrial fibrillation who presented to the emergency department (ED) following a syncopal episode with persistent hypotension.The patient's International Normalized Ratio (INR) returned elevated at 6.0, and a rapid bedside cardiac ultrasound revealed a large pericardial effusion consistent with cardiac tamponade.The anticoagulation was reversed and the patient underwent successful pericardiocentesis with removal of 1,100 mL of blood.

View Article: PubMed Central - PubMed

Affiliation: Kaiser Santa Clara Medical Center, Department of Emergency Medicine, Santa Clara, CA.

ABSTRACT
This case report describes a 54-year-old male on warfarin for atrial fibrillation who presented to the emergency department (ED) following a syncopal episode with persistent hypotension. The patient's International Normalized Ratio (INR) returned elevated at 6.0, and a rapid bedside cardiac ultrasound revealed a large pericardial effusion consistent with cardiac tamponade. The anticoagulation was reversed and the patient underwent successful pericardiocentesis with removal of 1,100 mL of blood.

No MeSH data available.


Related in: MedlinePlus