TY - CHAP M1 - Book, Section TI - Hemodynamics of Pericardial Disease A1 - Betz, Jarrod A1 - Lilly, Scott M. A2 - Baliga, R. R. A2 - Lilly, Scott M. A2 - Abraham, William T. PY - 2018 T2 - Color Atlas and Synopsis of Interventional Cardiology AB - A 53-year-old man presents with lower extremity swelling, shortness of breath, and abdominal fullness. He has a past medical history of non-Hodgkin lymphoma, hypertension, and gastro­esophageal reflux disease. He previously was treated with chemotherapy and radiation therapy and has been in remission for more than 10 years. Vital signs are heart rate of 110 bpm, blood pressure (BP) of 95/70 mm Hg, respiratory rate of 22 breaths/min, and 92% oxygen saturation on room air. Examination reveals distant heart tones, elevated jugular venous pressure to >15 cm, and clear lungs. There is 2+ pitting edema in the lower extremities with skin discoloration. Abdominal exam has shifting dullness and a tender, palpable liver edge. Chest radiograph shows clear lungs and mildly enlarged cardiac silhouette. Electrocardiogram has nonspecific ST/T changes with varying QRS and low voltages. Emergent bedside echocardiogram is obtained showing large, circumferential pericardial effusion with right ventricular diastolic collapse and significant variation with respiration in the mitral valve inflow velocity. A central venous catheter is placed, and the patient is taken to the cardiac catheterization lab where percutaneous pericardiocentesis is performed, with removal of 500 mL of serosanguinous-appearing fluid. BP improves to 114/82 mm Hg. Examination of the central venous pressure shows continued elevation to a mean pressure of 13 mm Hg with a change in morphology of the waveform after pericardial fluid removal. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accesscardiology.mhmedical.com/content.aspx?aid=1160206113 ER -