Localized pericarditis leading to clinical tamponade with profound shock status and syncope as a major clinical manifestation after posterior wall myocardial infarction—Characterization and descriptive findings by real-time 3-dimensional echocardiography

DOI: 10.4236/crcm.2013.24072   PDF   HTML   XML   2,683 Downloads   4,033 Views  

Abstract

Pericarditis and hemopericardium causing cardiac tamponade, caused by large and transmural ventricular infarction with subsequent rupture into the pericardium, is a rare complication post acute myocardial infarction. This is frequently fatal with rapid clinical course. We reported a 65-year-old female who presented with persistent diaphoresis and dyspnea for several hours followed by syncope. Acute myocardial infarction was diagnosed with primary percutaneous coronary intervention performed though persistent hypotension was observed. Moderate amount of hemopericardium leading to tamponade was found. It was relieved after pericardiocentesis. Real-time three-dimensional echocardiography revealed blood clot with specific whirling pattern around the infracted ventricular wall with suspected leak.

Share and Cite:

Chi, P. , Lo, C. , Hou, C. , Yeh, H. and Hung, C. (2013) Localized pericarditis leading to clinical tamponade with profound shock status and syncope as a major clinical manifestation after posterior wall myocardial infarction—Characterization and descriptive findings by real-time 3-dimensional echocardiography. Case Reports in Clinical Medicine, 2, 263-266. doi: 10.4236/crcm.2013.24072.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Dorfman, T.A. and Aqel, R. (2009) Regional pericarditis: A review of the pericardial manifestations of acute myocardial infarction. Clinical Cardiology, 32, 115-120. doi:10.1002/clc.20444
[2] Bainey, K.R. and Bhatt, D.L. (2009) Acute pericarditis: Appendicitis of the heart? Mayo Clinic Proceedings, 84, 5-6. doi:10.4065/84.1.5
[3] Oliva, P.B., Hammill, S.C. and Edwards, W.D. (1993) Electrocardiographic diagnosis of postinfarction regional pericarditis. Ancillary observations regarding the effect of reperfusion on the rapidity and amplitude of T wave inversion after acute myocardial infarction. Circulation, 88, 896-904. doi:10.1161/01.CIR.88.3.896
[4] Aydinalp, A., Wishniak, A., Van den Akker-Berman, L., Or, T. and Roguin, N. (2002) Pericarditis and pericardial effusion in acute ST-elevation myocardial infarction in the thrombolytic era. Israel Medical Association Journal, 3, 181-183.
[5] Køber, L., Møller, J.E. and Torp-Pedersen, C. (2010) Moderate pericardial effusion early after myocardial infarcttion: Left ventricular free wall rupture until proven otherwise. Circulation, 122, 1898-1899. doi:10.1161/CIRCULATIONAHA.110.986935
[6] Guereta, P., Khalifeb, K., Jobicc, Y., Fillipid, E., Isaaze, K., Tassan-Manginaf, S., Baixasg, C., Motreffh, P. and Meunei, C., (on Behalf of the Study Investigators) (2008) Echocardiographic assessment of the incidence of mechanical complications during the early phase of myocardial infarction in the reperfusion era: A French multicentre prospective registry. Archives of Cardiovascular Diseases, 101, 41-47. doi:10.1016/S1875-2136(08)70254-7
[7] Belkin, R.N., Mark, D.B. and Aronson, L. (1991) Pericardial effusion after intravenous recombinant tissue-type plasminogen activator for acute myocardial infarction. The American Journal of Cardiology, 67, 496. doi:10.1016/0002-9149(91)90010-I
[8] Widimsky, P. and Gregor, P. (1995) Pericardial involvement during the course of myocardial infarction. A longterm clinical and echocardiographic study. Chest, 108, 89. doi:10.1378/chest.108.1.89
[9] Sugiura, T., Iwasaka, T., Tarumi, N., et al. (1994) Clinical significance of pericardial effusion in Q-wave inferior wall myocardial infarction. The American Journal of Cardiology, 73, 862. doi:10.1016/0002-9149(94)90810-9
[10] Kaplan, K., Davison, R., Parker, M., Przybylek, J., Light, A., Bresnahan, D., et al. (1985) Frequency of pericardial effusion as determined by M-mode echocardiography in acute myocardial infarction. American Journal of Cardiology, 55, 335-337. doi:10.1016/0002-9149(85)90371-6
[11] Saito, Y., Donohue, A., Attai, S., Vahdat, A., Brar, R., Handapangoda, I., et al. (2008) The syndrome of cardiac tamponade with “small” pericardial effusion. Echocardiography, 25, 321-327. doi:10.1111/j.1540-8175.2007.00567.x
[12] Sugiura, T., Iwasaka, T., Takehana, K., et al. (1993) Clinical significance of pericardial effusion associated with pericarditis in acute Q-wave anterior myocardial infarction. Chest, 104, 415. doi:10.1378/chest.104.2.415
[13] Wilkenshoff, U.M., Ale Abaei, A., Kuersten, B., Pauschinger, M., Schwimmbeck, P., Hetzer, R., et al. (2004) Contrast echocardiography for detection of incomplete rupture of the left ventricle after acute myocardial infarction. Zeitschrift fur Kardiologie, 93, 624-629. doi:10.1007/s00392-004-0103-3
[14] Nemeth, M.A., Coulter, S. and Flamm, S.D. (2003) Pericarditis after myocardial infarction. Texas Heart Institute Journal, 30, 246-247.
[15] Möllmann, H., Zirlik, A., Nef, H.M., Weber, M., Hamm, C.W. and Elsässer, A. (2007) Left ventricular tamponade—A clinical chameleon. The Journal of Thoracic and Cardiovascular Surgery, 55, 325-327.

  
comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.