Abstract

We present two cases of cardiac tamponade presenting in the aftermath of cardiac surgery. We have briefly discussed the aetiology, presentation, diagnosis and management of the condition with emphasis on its atypical presentation in postoperative patients. A high index of suspicion and early access to echocardiography is necessary for prompt recognition and treatment of this life threatening emergency.

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References

1. Shabetai R. Pericardial effusion: haemodynamic spectrum. Heart 2004; 90: 255-256.
2. Guberman BA, Fowler NO, Engel PJ et al. Cardiac tamponade in medical patients. Circulation 1981; 64: 633-640.
3. Pepi M, Muratori M, Barbier P et al. Pericardial effusion after cardiac surgery: incidence, site, size and haemodynamic consequences. British Heart Journal 1994; 72: 327-331.
4. Ofori-Krakye SK, Tyberg TI, Geha AS et al. Late cardiac tamponade after open heart surgery: incidence, role of anticoagulants in its pathogenesis and its relationship to the postpericardiotomy syndrome. Circulation 1981; 63: 1323-1328.
5. Russo AM, O’Connor WH, Waxman HL. Atypical presentations and echocardiographic findings in patients with cardiac tamponade occurring early and late after cardiac surgery. Chest 1993; 104(1):71-78.
6. Kuvin JT, Harati NA, Pandian NG et al. Postoperative cardiac tamponade in the modern surgical era. The Annals of Thoracic Surgery 2002; 74(4): 1148-1153.
7. Shah A, Brink A, Mol B. Raised International Normalised Ratio: an early warning for a late cardiac tamponade. The Annals of Thoracic Surgery 2006; 82: 1090-1091.
8. Malouf JF, Alam S, Stefadouros MA. The role of anticoagulation in the development of pericardial effusion and late tamponade after cardiac surgery. European Heart Journal 1993; 14(11): 1452-1457.
9. Chuttani K, Tischler MD, Pandian NG et al. Diagnosis of cardiac tamponade after cardiac surgery: Relative value of clinical, echocardiographic and hemodynamic signs. American Heart Journal 1994; 127(4): 913-918.
10. Price S, Prout J, Jagger S I et al. ‘Tamponade’ following cardiac surgery: terminology and echocardiography may both mislead. European Journal of Cardiothoracic Surgery 2004; 26: 1156-1160.
11. Engle MA, Gay WA, Kaminsky ME et al. The postpericardiotomy syndrome then and now. Current Problems in Cardiology 1978; 3(2): 1-40.
12. Tsang TS, Barnes ME, Hayes SN et al. Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo-guided pericardiocentesis for management: Mayo Clinic experience, 1979-1998. Chest 1999; 116(12): 322-331.
13. Seeto RK, Fenn B, Rockey DC. Ischaemic hepatitis: clinical presentation and pathogenesis. American Journal of Medine 2000; 109(2): 109-113
14. Delgado C, Barturen F. Atrial tamponade causing acute ischaemic hepatic injury after cardiac surgery. Clinical Cardiology 1999; 22: 242-244.
15. Rex DK, Rogers DW, Mohammed Y et al. Post-cardiac surgery tamponade mimicking acute hepatitis. Journal of Clinical Gastroentrology 1992; 14(2): 136-138.
16. Gibson PR, Dudley FJ. Ischaemic hepatitis: clinical features, diagnosis and prognosis. Australian and New Zealand Journal of Medicine 1984; 14(6): 822-825.
17. Gitlin N, Serio KM. Ischaemic Hepatitis: Widening Horizons. American Journal of Gastroenterology 1992; 87(7): 831-836.
18. Delgado MC, Levis JT. Hemopericardium and cardiac tamponade in a patient with elevated International Normalised Ratio. Western Journal of Emergency Medicine 2009; 10(2): 115-119.
19. Lee KS, Marwick T. Hemopericardium and cardiac tamponade associated with warfarin therapy. Cleveland Clinical Journal of Medicine 1993; 60(4): 336-338.
20. Hanley JP. Warfarin reversal. Journal of Clinical Pathology 2004; 57:1132-1139.
21. Wijdicks EF, Schievink WI, Brown RD et al. The dilemma of discontinuation of anticoagulation therapy for patients with intracranial hemorrhage and mechanical heart valves. Neurosurgery 1998; 42(4): 769-773.
22. Tsang TS, Oh JK, Seward JB. Diagnosis and management of cardiac tamponade in the era of echocardiography. Clinical Cardiology 1999; 22(7): 446-452.
23. Salem K, Mulji A, Lonn E. Echocardiographically guided pericardiocentesis – the gold standard for the management of pericardial effusion and cardiac tamponade. Canadian Journal of Cardiology 1999; 15(11): 1251-1255.
24. Fagan SM. Pericardiocentesis: Blind no more! Chest 1999; 116: 275-276.
25. Tsang TS, Enriquez-Sarano M, Freeman WK. Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: Clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clinic Proceedings 2002; 77(5): 429-436.
26. Tsang TS, Barnes ME, Gersh BJ et al. Outcomes of clinically significant idiopathic pericardial effusion requiring intervention. American Journal of Cardiology 2003; 91(6): 704-707.
27. Callahan JA, Seward JB. Pericardiocentesis guided by twodimensional echocardiography. Echocardiography 1997; 14(5): 497-50