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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An acute cardiac tamponade from any cause may result in rapid deterioration of hepatic function in a previously healthy patient. We describe a case of an acute ascending aortic dissection that presented as acute hepatic failure, due to an acute cardiac tamponade and severe right heart failure. The differential diagnosis of the aetiology of acute liver failure is extensive and includes poisonings, vascular obstruction and sepsis, particularly on the background of decompensated liver disease. Many of these conditions are associated with hypotension. The acute presentation in our patient, combined with the lack of a characteristic history delayed the diagnosis of a proximal (type A) dissection with tamponade and subsequent hepatic failure. Severe right-sided heart failure as a result of conditions such as cardiac tamponade should be excluded in patients presenting with acute hepatic failure of unknown aetiology.
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PMID:Acute hepatic failure caused by an acute aortic dissection with cardiac tamponade: a case report. 1656 89

Severe septicaemia secondary to melioidosis carries a high mortality. Although melioidosis can involve most tissues and organs, pericardial involvement is rare. We report a 40-yearold woman with melioidosis with pericardial involvement but no contiguous pulmonary involvement. She developed acute pericardial tamponade but was successfully treated with surgery and medical therapy. This is the first case in Australia or New Zealand of melioid sepsis presenting with pericarditis and subsequent cardiac tamponade. We review the literature on cardiac involvement in melioidosis.
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PMID:Burkholderia pseudomallei sepsis presenting with pericardial effusion and tamponade. 1852 28

The aim of this study was to investigate how a continuous quality improvement (CQI) program affected major morbidity and postoperative outcomes after cardiac surgery. Patients were divided into 2 groups: those who underwent surgery (coronary artery bypass grafting, isolated valve surgery, or coronary artery bypass grafting and valve surgery) after the establishment of a CQI program (from January 2005 to December 2006, n = 922) and those who underwent surgery beforehand (from January 2002 to December 2003, n = 1,289). Patients who had surgery in 2004, when the system and processes were reengineered, were not included in the analysis. Outcomes compared between the 2 groups included (1) acute renal failure, (2) stroke, (3) sepsis, (4) hemorrhage-related reexploration, (5) cardiac tamponade, (6) mediastinitis, and (7) prolonged length of stay. Logistic regression analysis and propensity score adjustment were used to adjust for imbalances in the patients' preoperative characteristics. After propensity score adjustment, CQI was found to decrease the rate of sepsis (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.3 to 0.9, p = 0.02) and cardiac tamponade (OR 0.2, 95% CI 0.04 to 0.8, p = 0.02) but to only marginally decrease the rate of acute renal failure (OR 0.7, 95% CI 0.5 to 1.0, p = 0.07). CQI did not emerge as an independent risk factor for hemorrhage-related reexploration, prolonged length of stay, mediastinitis, or stroke in either multivariate logistic regression analysis or propensity score adjustment. In conclusion, the systematic implementation of a CQI program and the application of multidisciplinary protocols decrease sepsis and cardiac tamponade after cardiac surgery.
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PMID:Continuous quality improvement program and major morbidity after cardiac surgery. 1877 5

We describe two cases of Reactive Hemophagocytic syndrome (RHS) occurring in rheumatic diseases in childhood. Patient 1, an adolescent girl with systemic onset Juvenile idopathic arthritis (JRA) presented like severe sepsis with shock, hepatic dysfunction and coagulopathy. Patient 2 presented with cardiac tamponade, she was later detected to have systemic lupus erythematosus (SLE). Her bone marrow aspirate revealed prominent hemophagocytosis. Both cases improved with pulse methylprednisolone therapy.
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PMID:Reactive hemophagocytic syndrome. 1881 Mar 57

Since the advent of antibiotics, bacterial pericarditis has become relatively rare. Cardiac tamponade is a potentially lethal complication, especially when caused by methicillin-resistant Staphylococcus aureus (MRSA). In the intensive care setting other predisposing factors for purulent pericarditis, besides immunosuppression, are the high incidence of nasal and skin colonization and invasive techniques such as indwelling catheters. We present two case reports of cardiac tamponade in young patients, with underlying immunosuppression of different etiologies (HIV infection and liver transplantation). In both, clinical evolution was complicated by severe sepsis, with MRSA being isolated in various biological products, followed by bacterial pericarditis and tamponade. The authors highlight the need for a high degree of suspicion for the diagnosis of bacterial pericarditis in immunosuppressed patients, an ever-growing population, as well as the importance of echocardiographic monitoring during clinical evolution.
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PMID:Cardiac tamponade secondary to methicillin-resistant Staphylococcus aureus pericarditis. 1895 91

Exudative pericarditis is found in 30-50% of the patients with rheumatoid arthritis (RA), particularly in later stages of the disease. Most cases present with no or few symptoms. We report a case of a 68 year-old male with a history of mild RA who developed exudative pericarditis leading to recurrent cardiac tamponade requiring repeated pericardiocenteses. Treatment with glucocorticosteroids, methotrexate and colchicine proved ineffective in preventing the recurrences. Immunosuppression contributed to the development of sepsis caused by Enterobacter cloacae and resulting in the patient's death.
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PMID:[Recurrent cardiac tamponade and sepsis in a patient with rheumatoid arthritis]. 2192 8

Paramedics bring into the ED an elderly man who is complaining of right-sided chest and abdominal pain. Earlier this morning, a friend had arrived at the patient's home and found him on the floor at the bottom of the stairs. The patient is in pain, somewhat altered, and unable to provide further details about what happened. After numerous attempts, the paramedics were only able to place a 22-gauge peripheral line. On examination, his blood pressure is 98/55 mm Hg, heart rate is 118 beats per minute, respiratory rate is 32 breaths per minute, oxygen saturation is 94% on a nonrebreather, and temperature is 36.0 degrees C (96.8 degrees F). His Glasgow Coma Scale score is 12 (eyes 3, verbal 4, motor 5). Given the unclear events surrounding his presentation and the concern for trauma, the patient is boarded and collared. His chest is stable but tender, and because of noise in the resuscitation room, you have difficulty auscultating breath sounds. The abdominal examination is notable for marked tenderness over the right upper quadrant and right flank, with some guarding. There is also mild asymmetric swelling of his right lower extremity. The patient is critically ill, his history is limited, and at this point the differential is quite broad. You consider the possibility of a syncopal episode followed by a fall, with a closed head injury, blunt thoracic trauma, and blunt abdominal trauma. His hypotension could be secondary to hypovolemia (dehydration or blood loss due to a ruptured aortic aneurysm), heart failure (left- or right-sided dysfunction), cardiac tamponade, tension pneumothorax, or sepsis. Your ED recently purchased an ultrasound machine, you wonder whether bedside ultrasound can help narrow the differential and guide your resuscitation. You call over one of your new faculty members who just finished resident training; a fortunate decision for both you and the patient.
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PMID:An evidence-based approach to emergency ultrasound. 2216 3

A 37-year-old Caucasian female with known rheumatic mitral stenosis was admitted for Balloon mitral valvuloplasty which was complicated with a laceration of anterior mitral leaflet (A2 scallop) resulting in severe mitral regurgitation. Intra-aortic balloon pump (IABP) was instituted and the patient was referred for emergency mitral surgery. During surgery anterior mitral leaflet was excised. Most of the posterior leaflet was preserved. Mitral valve was replaced with St Jude mitral mechanical valve. Operation was uneventful and patient's recovery was uncomplicated. Complications associated with mitral valvuloplasty include ventricular perforation, leaflet laceration, rupture of chordae, sepsis, cardiac tamponade and premature ventricular contractions. Torrential mitral regurgitation postvalvuloplasty is a serious, life-threatening complication. Considering the risk of serious complication associated with percutaneous mitral balloon valvuloplasty (PMBV), this procedure should be performed in qualified cardiac catheterisation labs with a backup facility of cardiac surgery to deal with any potential life-threatening complications.
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PMID:Laceration of anterior mitral leaflet postpercutaneous balloon mitral valvuloplasty for rheumatic mitral stenosis. 2324 92

Massive purulent andacute pericarditis in children is a life-threatening disease associated with high mortality. It has been described tocomplicate usuallya bronchopulmonary infectionbut is currently uncommon in the era of antibiotics. Acute and massive purulent pericarditis has been rarely reported in children in association with human immunodeficiency virus (HIV) infection. This is a case of a10-year-old boy who presented with signs of sepsis and cardiac tamponade due to a massive staphylococcal purulent pericarditis complicating an unknown HIV infection.The child underwent pericardiectomy, intensive treatment, and survived this life-threatening disease.
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PMID:Human immunodeficiency virus infection in a child revealed by a massive purulent pericarditis mistaken for a liver abscess due to Staphylococcus aureus. 2565 55

Pyopericardium is a rare condition with a high mortality rate in which infection propagates in the pericardial space, leading to a pus filled pericardial effusion and cardiac tamponade, which can cause cardiogenic shock and death. We present a case of a previously healthy woman of 52, who was admitted with a severe lower respiratory tract infection that eventually led to a pyopericardium. The diagnosis of pyopericardium was delayed due to masking of symptoms by her underlying infection, sepsis and an upper gastrointestinal bleed that the patient suffered during the admission, requiring an emergency gastroscopy. The pyopericardium was considered when ST elevation was seen on an ECG and an ECHO discovered a large pericardial effusion causing tamponade. An emergency pericardiocentesis drained frank pus. Treatment with intravenous antibiotics, frequent pericardial drainage and a pericardectomy led to an excellent outcome, and a full recovery.
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PMID:The unmasking of a pyopericardium. 2573 19


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