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Echocardiography of isolated subacute left heart tamponade in a patient with cor pulmonale and circumferential pericardial effusion.

Mars T, Mikolavcic H, Salobir B, Podbregar M - Cardiovasc Ultrasound (2010)

Bottom Line: It is the result of increased transudation and impaired re-absorption due to elevated venous pressure.These patients have pre-existent symptoms and signs of chronic right heart failure.Transthoracic echocardiography provides a rapid access to the correct diagnosis, a prompt relief of symptoms following the ultrasound guided pericardiocentesis and important diagnostic tool for regular follow up of patients thereafter as shown in our case report.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Slovenia.

ABSTRACT
Patients with advanced idiopathic pulmonary artery hypertension have often a chronic pericardial effusion. It is the result of increased transudation and impaired re-absorption due to elevated venous pressure. These patients have pre-existent symptoms and signs of chronic right heart failure. High degree of suspicion is required to detect of development of an atypical form of tamponade with isolated compression of left heart chambers as shown in present case report. Transthoracic echocardiography provides a rapid access to the correct diagnosis, a prompt relief of symptoms following the ultrasound guided pericardiocentesis and important diagnostic tool for regular follow up of patients thereafter as shown in our case report.

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Transthoracic echocardiography from short-axis plane at the papillary muscle level shows enlarged right ventricle (RV) with paradoxical movement of intraventricular septum. Left ventricle is compressed by RV and pericardial effusion (PE).
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Figure 4: Transthoracic echocardiography from short-axis plane at the papillary muscle level shows enlarged right ventricle (RV) with paradoxical movement of intraventricular septum. Left ventricle is compressed by RV and pericardial effusion (PE).

Mentions: A 57-year-old patient with IPAH and a previously known chronic pericardial effusion presented in an outpatient clinic with symptoms of dyspnea on exertion, in the last days even at rest, ortopnea and leg edema. During the past few months he was in good physical condition. He was on therapy with sildenafil, amlodipine, acenocoumarol and had a combination inhaler containing fluticasone propionate and salmeterol xinafoate. The clinical examination showed distended jugular veins, leg edema and an accentuated second heart sound. A chest radiogram showed an enlarged heart shadow. The echocardiographic examination showed a dilated right atrium and ventricle (Figure 1) with reduced ejection fraction, severe tricuspid insufficiency (Figure 2), systolic right ventricular pressure 82 mm Hg plus central venous pressure (Figure 3), the inferior vena cava larger than 2.5 cm with no respiration variability. Clinically estimated central venous pressure was approximately 20 mm Hg. Compared with the previous transthoracic echocardiographic examination, there was enlarged pericardial effusion, 3 cm behind the left ventricular posterior (Figure 4) wall with diastolic collapse of left atrium and ventricle (Additional files 1, 2 and 3).


Echocardiography of isolated subacute left heart tamponade in a patient with cor pulmonale and circumferential pericardial effusion.

Mars T, Mikolavcic H, Salobir B, Podbregar M - Cardiovasc Ultrasound (2010)

Transthoracic echocardiography from short-axis plane at the papillary muscle level shows enlarged right ventricle (RV) with paradoxical movement of intraventricular septum. Left ventricle is compressed by RV and pericardial effusion (PE).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2913935&req=5

Figure 4: Transthoracic echocardiography from short-axis plane at the papillary muscle level shows enlarged right ventricle (RV) with paradoxical movement of intraventricular septum. Left ventricle is compressed by RV and pericardial effusion (PE).
Mentions: A 57-year-old patient with IPAH and a previously known chronic pericardial effusion presented in an outpatient clinic with symptoms of dyspnea on exertion, in the last days even at rest, ortopnea and leg edema. During the past few months he was in good physical condition. He was on therapy with sildenafil, amlodipine, acenocoumarol and had a combination inhaler containing fluticasone propionate and salmeterol xinafoate. The clinical examination showed distended jugular veins, leg edema and an accentuated second heart sound. A chest radiogram showed an enlarged heart shadow. The echocardiographic examination showed a dilated right atrium and ventricle (Figure 1) with reduced ejection fraction, severe tricuspid insufficiency (Figure 2), systolic right ventricular pressure 82 mm Hg plus central venous pressure (Figure 3), the inferior vena cava larger than 2.5 cm with no respiration variability. Clinically estimated central venous pressure was approximately 20 mm Hg. Compared with the previous transthoracic echocardiographic examination, there was enlarged pericardial effusion, 3 cm behind the left ventricular posterior (Figure 4) wall with diastolic collapse of left atrium and ventricle (Additional files 1, 2 and 3).

Bottom Line: It is the result of increased transudation and impaired re-absorption due to elevated venous pressure.These patients have pre-existent symptoms and signs of chronic right heart failure.Transthoracic echocardiography provides a rapid access to the correct diagnosis, a prompt relief of symptoms following the ultrasound guided pericardiocentesis and important diagnostic tool for regular follow up of patients thereafter as shown in our case report.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Slovenia.

ABSTRACT
Patients with advanced idiopathic pulmonary artery hypertension have often a chronic pericardial effusion. It is the result of increased transudation and impaired re-absorption due to elevated venous pressure. These patients have pre-existent symptoms and signs of chronic right heart failure. High degree of suspicion is required to detect of development of an atypical form of tamponade with isolated compression of left heart chambers as shown in present case report. Transthoracic echocardiography provides a rapid access to the correct diagnosis, a prompt relief of symptoms following the ultrasound guided pericardiocentesis and important diagnostic tool for regular follow up of patients thereafter as shown in our case report.

Show MeSH
Related in: MedlinePlus