VCOM Research Day Program Book 2023

Medical Resident Research Case Reports

13 Subacute Cardiac Tamponade

Conner Kirkikis, DO; Sidrah Ghaffar, DO Corresponding author: Conner.kirkikis@lpnt.net

SOVAH Health Internal Medicine Residency Program

was placed on two vasopressors. An echocardiogram was in progress to evaluate for tamponade when the patient went into asystole. The patient expired before pericardiocentesis was able to be performed. Comments: Cardiac tamponade is a life threatening condition. Temporizing measures such as IV fluid administration and avoidance of positive pressure ventilation and inotropic agents should be implemented until definitive treatment with pericardiocentesis, bedside or surgical, can be performed.

Context: Cardiac tamponade can be a rapidly developing and deadly condition that needs to be recognized quickly for prompt intervention. Muffled heart sounds, jugular venous distension, and hypotension are often observed in severe cases. Cardiac tamponade has many etiologies, including iatrogenic, malignancy, post-myocardial infarction, uremia, and infection; however, a large portion remains idiopathic. Case Report: 74-year-old Caucasian female presents to the emergency department for evaluation of difficulty breathing. Medical History: Parkinson’s disease, COPD on 2L oxygen, OSA, Hypothyroidism, Chronic opioid dependence with intrathecal pain pump. Family History: Diabetes mellitus. Social History: Lives with family. Independent of all activities of daily living. Pertinent Review of Systems: Shortness of breath.

Pertinent Physical Exam: Obese female. In respiratory distress, jugular venous distension up to mid-neck, course breath sounds in bilateral fields, fatigued. Pertinent Labs: Hemoglobin 7.6, Sodium 132, Potassium 6.9, Creatinine 2.95, AST 83, ALT 11, Alkaline phosphatase 648, BNP 295, pH 7.17, pCO2 52, pO2 129, Bicarbonate 22, Lactic acid 3.3. Imaging: CT Chest/Abdomen/Pelvis without IV contrast, Echocardiogram. Diagnosis: Cardiopulmonary arrest secondary to cardiac tamponade. Acute on chronic hypoxic respiratory failure requiring mechanical ventilation secondary to bilateral pleural effusions and cardiac tamponade. Obstructive shock. Large bilateral pleural effusions. Severe acute hyperkalemia. Treatment: The patient was placed on BiPAP for respiratory support and given temporizing measures for hyperkalemia. IV fluids were started. After a rapid deterioration, the patient was intubated. The patient’s hemodynamic instability worsened, and she

30