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• W4387249315 abstract "SESSION TITLE: Cardiovascular Disease Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Pericardial effusion with tamponade physiology is a true emergency with significant mortality risk. Clinical manifestations could include lightheadedness, fatigue, dyspnea, or chest discomfort. It's important to be mindful of hemopericardium in patients on anticoagulation medications. CASE PRESENTATION: A 65-year-old female with COPD, factor V Leiden and previous deep vein thrombosis,on warfarin presented with complaints of malaise for a week and recent fall while trying to get into her wheelchair from bed. Her presenting vitals included blood pressure of 93/67mmHg, heart rate of 71 beats per minute, saturating well on room air. Laboratory data was significant for elevated lactic acid and acute kidney injury. She was started on fluids and antibiotics for sepsis. She hadn't been taking her warfarin for last 4 days as her INR level was 10. She became progressively more hypotensive and obtunded with cold and clammy extremities. Stat bedside echo revealed a large pericardial effusion with non-collapsible IVC, excessive tricuspid respiratory variation, and hypotension consistent with tamponade physiology. Her INR level returned as 25 and she received a vitamin K along with 4 units of FFP. She underwent urgent pericardiocentesis. One Liter of rose-colored pericardial fluid was removed, and she was transferred to the ICU. Her hemodynamics continued to deteriorate, and she required escalating doses of vasopressors. Bedside POCUS showed persistent large pericardial effusion. Pericardial catheter was not draining and was flushed, following which more than 1 liter of bloody pericardial fluid was removed and was put at -20 pressure suction. Repeat bedside echo continued to show a large complicated fibrinous pericardial effusion. While patient was getting prepared for pericardial window, the patient went into asystole and aggressive resuscitation was unsuccessful. DISCUSSION: Patients with coagulation disorders or on medications that alter coagulation are at higher risk of bleeding. In this population, hemopericardium should be on differential and be ruled out before it progresses to cardiac tamponade. CONCLUSIONS: Point of care ultrasound should be used in patients presenting with vague nonspecific symptoms and hypotension, especially in those on anticoagulant therapy. REFERENCE #1: Spodick DH. Acute cardiac tamponade. N Engl J Med. 2003 Aug 14;349(7):684-90. doi: 10.1056/NEJMra022643. PMID: 12917306. DISCLOSURES: No relevant relationships by Rimsha Ali No relevant relationships by Aslan Amirian No relevant relationships by Hanna Bobrysheva No relevant relationships by Konstantin Golubykh No relevant relationships by Iuliia Kovalenko No relevant relationships by Taaha Mirza No relevant relationships by Navitha Ramesh No relevant relationships by Bosky Soni" @default.
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• W4387249315 date "2023-10-01" @default.
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• W4387249315 title "FATIGUE AS THE INITIAL PRESENTATION LEADING TO A DIAGNOSIS OF HEMOPERICARDIUM" @default.
• W4387249315 doi "https://doi.org/10.1016/j.chest.2023.07.243" @default.
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