Recognition of cardiac tamponade in the presence of severe pulmonary hypertension

Article Abstract:

Cardiac tamponade occurs when blood or fluid collects in the sac surrounding the heart, causing compression of the heart. Symptoms may include difficulty breathing, increased pressure in the veins and a paradoxical pulse. The recognition of cardiac tamponade is more difficult in patients with pulmonary hypertension, high blood pressure originating in the lung circulation. Since these patients may have difficulty breathing and increased pressure in the veins, cardiac tamponade may be missed. A 44-year-old woman with pulmonary hypertension and pericardial effusion (fluid leaking into the sac surrounding the heart) caused cardiac tamponade. The typical paradoxical pulse (pulsus paradoxus) and high right ventricular diastolic pressure, as seen on echocardiogram, were absent in this patient. Instead, collapse of the left ventricular cavity during diastole was found. Left ventricular diastolic collapse in the absence of right ventricular diastolic collapse can be used to recognize cardiac tamponade in patients with pulmonary hypertension. Drainage of cardiac fluid restored heart functioning. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Physiological aspects, Pulmonary hypertension, Pericardial effusion, Cardiac tamponade

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Whipple Endocarditis without Overt Gastrointestinal Disease: Report of Four Cases

Article Abstract:

Whipple's disease, a gastrointestinal disease, may not be detected in patients with endocarditis, and the absence of clinical, microscopic, or microbiological evidence of gastrointestinal disease does not rule out T. whippelii, which may be the cause. Cardiac manifestations of Whipple disease are rarely diagnosed before death. In the cases of three men and one woman undergoing replacement of insufficient heart valves due to endocarditis, Tropheryma whippelii was found in the heart valves (three aortic valves and one mitral valve). All patients had arthralgia which resolved promptly with antibiotic therapy. Disease did not recur in any patient after prolonged antibiotic therapy with cotrimoxazole.

Statistical Data Included, Evaluation, Causes of, Drug therapy, Endocarditis

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Cardiac Whipple disease: identification of Whipple bacillus by electron microscopy in the myocardium of a patient before death

Article Abstract:

It appears possible to identify before death and successfully treat patients with Whipple disease. Most patients with Whipple disease are not identified until after death. Doctors initially used heart scans, magnetic resonance images, computed tomography, and laboratory test results to identify the source of characteristic signs of congestive heart failure and abdominal complications in a 44-year-old woman. Examination of a heart tissue sample with an electron microscope revealed the bacteria responsible for Whipple disease. Treatment with trimethoprim-sulfamethoxazole and a pacemaker was successful.

Medical examination, Heart muscle, Myocardium

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