Cardiac tamponade masquerading as gastritis: a case report

Journal of Medical Case Reports

Elkhashab Mohamed¹  Ameri Allen¹  Tantoush Hamza¹  Tella Sri Harsha¹  Abuzaid Ahmed¹ 

[1] Creighton University Medical Center, 601 30th street, 5th floor, Omaha, NE 68131, USA

关键词: Tamponade;    Pulsus paradoxus;    Pericardial effusion;    Echocardiography;   

Others  :  1181088
DOI  :  10.1186/1752-1947-8-264

 received in 2014-03-05, accepted in 2014-06-02,  发布年份 2014

【 摘 要 】

Introduction

Pericardial effusion and cardiac tamponade can develop in patients with virtually any condition that affects the pericardium. A high index of suspicion with proper diagnostic scheme can lessen the concomitant morbidity and mortality. Although cardiac tamponade mimics many medical conditions, internists and primary care physicians should be aware of the physiological and clinical aspects of the disease spectrum.

Case presentation

A 31-year-old Caucasian man, with no significant past medical history, presented to our emergency room with acute upper abdominal heaviness of 2 hours’ duration after drinking excessive amounts of alcohol in a short period of time (binge drinking). The coexistence of recent alcohol binge drinking and nonspecific abdominal complaints usually presume a diagnosis of gastritis in our daily encounters in the absence of hepatic, biliary or pancreatic derangements. We present a case in which the presenting abdominal pain turned out to be related to cardiac tamponade.

Conclusions

Cardiac tamponade is a sort of cardiogenic shock and is a medical emergency. Clinicians should understand the cardiac tamponade physiology, especially in cases without large pericardial effusion, and correlate the signs of clinical tamponade together with the echocardiographic findings. Drainage of cardiac tamponade is life-saving. A high index of suspicion with proper diagnostic arcades lessens the concomitant morbidity and mortality.

【 授权许可】

   
2014 Ahmed et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]LeWinter MM: Pericardial diseases. In Braunwald’s Heart Disease, A Textbook of Cardiovascular Medicine. 8th edition. Edited by Libby P, Bonow RO. Philadelphia: Saunders Elsevier; 2008:1829-1854.
• [2]Spodick DH: Acute cardiac tamponade. N Engl J Med 2003, 349(7):684-690.
• [3]Spodick DH: How do the clinical findings in patients with pericardial effusions influence the success of aspiration? Br Heart J 1995, 74(4):476.
• [4]Weekes AJ, Quirke DP: Emergency echocardiography. Emerg Med Clin North Am 2011, 29(4):759-787. vi-vii. doi:10.1016/j.emc.2011.08.002. Epub 2011 Sep 23
• [5]Perera P, Lobo V, Williams SR, Gharahbaghian L: Cardiac echocardiography. Crit Care Clin 2014, 30(1):47-92. v. doi:10.1016/j.ccc.2013.08.003
• [6]Sagrista-Sauleda J, Angel J, Sambola A, Permanyer-Miralda G: Hemodynamic effects of volume expansion in patients with cardiac tamponade. Circulation 2008, 117(12):1545-1549.
• [7]Abusaid GH, Khalife WI: Reduced coronary blood flow in cardiac tamponade: mystery solved. J Invasive Cardiol 2012, 24(12):E328-E329.
• [8]Sagrista-Sauleda J, Merce AS, Soler-Soler J: Diagnosis and management of pericardial effusion. World J Cardiol 2011, 3(5):135-143.
• [9]American College of Emergency Physicians: Emergency ultrasound guidelines. Ann Emerg Med 2009, 53(4):550-570.
• [10]Ariyarajah V, Spodick DH: Cardiac tamponade revisited: a postmortem look at a cautionary case. Tex Heart Inst J 2007, 34(3):347-351.
• [11]Hashim R, Frankel H, Tandon M, Rabinovici R: Fluid resuscitation-induced cardiac tamponade. J Trauma 2002, 53(6):1183-1184.
• [12]Jung HO: Pericardial effusion and pericardiocentesis: role of echocardiography. Korean Circ J 2012, 42(11):725-734.
• [13]Spodick DH: Images in cardiology. Truly total electric alternation of the heart. Clin Cardiol 1998, 21(6):427-428.
• [14]Ivens EL, Munt BI, Moss RR: Pericardial disease: what the general cardiologist needs to know. Heart (British Cardiac Society) 2007, 93(8):993-1000.
• [15]Seidenberg PH, Haynes J: Pericarditis: diagnosis, management, and return to play. Curr Sports Med Rep 2006, 5(2):74-79.
• [16]Holmes DR Jr: Iatrogenic pericardial effusion and tamponade in the percutaneous intracardiac intervention era. JACC Cardiovasc Interv 2009, 2(8):705-717.
• [17]Adhikari S, Fiorello A, Stolz L, Jones T, Amini R, Gross A, O'Brien K, Mosier J, Blaivas M: Ability of emergency physicians with advanced echocardiographic experience at a single center to identify complex echocardiographic abnormalities. Am J Emerg Med 2014, 32(4):363-366. doi:10.1016/j.ajem.2013.12.010. Epub 2013 Dec 12