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Arsen D. Ristić, Massimo Imazio, Yehuda Adler, Aristides Anastasakis, Luigi P. Badano, Antonio Brucato, Alida L. P. Caforio, Olivier Dubourg, Perry Elliott, Juan Gimeno, Tiina Helio, Karin Klingel, Aleš Linhart, Bernhard Maisch, Bongani Mayosi, Jens Mogensen, Yigal Pinto, Hubert Seggewiss, Petar M. Seferović, Luigi Tavazzi, Witold Tomkowski, Philippe Charron, Triage strategy for urgent management of cardiac tamponade: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases, European Heart Journal, Volume 35, Issue 34, 7 September 2014, Pages 2279–2284, https://doi.org/10.1093/eurheartj/ehu217
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Extract
Introduction
Prompt recognition of cardiac tamponade is critical since the underlying haemodynamic disorder can lead to death if not resolved by percutaneous or surgical drainage of the pericardium. Cardiac tamponade is a condition caused by the compression of the heart due to slow or rapid accumulation of fluid (exudate), pus, blood, clots, or gas within the pericardial space resulting in impaired diastolic filling and cardiac output due to increased intrapericardial pressure.1–3
Pericardial diseases of any aetiology may cause cardiac tamponade, but with highly variable incidence reflecting the local epidemiological background (Table 1).3–6 However, all interventional procedures (i.e. percutaneous coronary intervention, transcatheter aortic valve implantation, pacemaker/implantable cardioverter defibrillator implantation, arrhythmias ablation, endomyocardial biopsy) are emerging causes of cardiac tamponade.7 Although rare, cardiac tamponade may also occur in pregnancy and in post-partum.8,9 Thus cardiologists should be aware of this possibility including specific contraindications for pregnancy (i.e. avoid the use of colchicine and X-ray exposure using echo-guided procedure).13,14
Comments
The position statement on cardiac tamponade fills an important gap on this need by providing a reasonable triage strategy for urgent management of this life-threatening condition. However, in my opinion, two issues need to be clarified in this article. First, in Table 1, it was stated that transudative pericardial effusions caused by heart failure never progress to tamponade. However, no references was given for this specific data. No discussion on this regard was held in the references 3 to 6 which were supplied for Table 1 as well. I believe this interesting information is clinically relevant because it implies that further investigation should be carried out when a patient with heart failure presents with cardiac tamponade. Second, it has been well-known that rapid drainage of more than 1 L pericardial fluid may result in acute right ventricular dilatation [1]. However, whether this is also true for the left ventricle is not clear. Accordingly, there is a need for citation for the information given under the subheading of "how to prevent complications" that large volume pericardiocentesis can be followed by transient severe acute left ventricular systolic failure in the absence of any prior history of left ventricular dysfunction.
Sincerely
Reference 1. Armstrong WF, Feigenbaum H, Dillon JC. Acute right ventricular dilation and echocardiographic volume overload following pericardiocentesis for relief of cardiac tamponade. Am Heart J. 1984 Jun;107(6):1266-1270.
Conflict of Interest:
None declared