Abstract
Abstract 14496: ST-revelations: Thinking Critically in the Critically Ill
Circulation (New York, N.Y.), Vol.140(Suppl 1), pp.A14496-A14496
11/19/2019
DOI: 10.1161/circ.140.suppl_1.14496
Abstract
IntroductionPurulent pericarditis accounts for less than 1% of pericarditis cases in developed countries and portends a very poor prognosis. Of these, Group A streptococcus is extremely rare, as is an initial presentation of cardiac tamponade. This case represents a diagnostic dilemma in a patient presenting with an acute current of injury and cardiovascular collapse requiring astute decision making.CaseA 45 year old woman presented to a local emergency department complaining of chest pain after being found confused outside. An EKG revealed ST-elevations, and our hospital was contacted for consideration of emergent intervention given concern for myocardial infarction. During transport the patient continued to deteriorate and required intubation and the initiation of vasopressors. Upon arrival, coronary angiography showed no evidence of acute plaque rupture, but in the setting of ongoing hemodynamic instability the need to establish a diagnosis was critical. Pulsus paradoxus was noted, and EKG was concerning for electrical alternans. Simultaneous right heart catheterization and bedside echocardiogram were done which revealed elevated and equalized diastolic pressures and a pericardial effusion with concern for tamponade physiology. An emergent pericardiocentesis was performed and 160cc of frank pus was aspirated from her pericardial space with immediate hemodynamic improvement. Cultures subsequently grew Group A streptococcus. She underwent a pericardial window, was treated with antibiotics, and recovered without major sequelae.ConclusionThis case highlights the importance of constructing a differential diagnosis quickly in a critically ill patient, especially when considering non-ischemic causes of cardiovascular collapse in the setting of ST-elevations. Clinicians must be proactive as new information becomes available, and use a team based approach to deal with unexpected findings and initiate treatment appropriately.
Details
- Title: Subtitle
- Abstract 14496: ST-revelations: Thinking Critically in the Critically Ill
- Creators
- Zachary Il’Giovine - Cleveland ClinicJerry Lipinski - Cleveland ClinicRuchi Sharma - Cleveland ClinicDivyang Patel - Cleveland ClinicVenu Menon - Cleveland ClinicAllan Klein - Cleveland ClinicSteven Nissen - Cleveland Clinic
- Resource Type
- Abstract
- Publication Details
- Circulation (New York, N.Y.), Vol.140(Suppl 1), pp.A14496-A14496
- Publisher
- by the American College of Cardiology Foundation and the American Heart Association, Inc
- DOI
- 10.1161/circ.140.suppl_1.14496
- ISSN
- 0009-7322
- eISSN
- 1524-4539
- Language
- English
- Date published
- 11/19/2019
- Academic Unit
- General Internal Medicine; Internal Medicine
- Record Identifier
- 9984694760002771
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