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ISSN: 2329-9517
Journal of Cardiovascular Diseases & Diagnosis
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A "Swimming" Heart

Marcello Di Valentino1*, Vito Spataro2 and Andreas Perren3
1Department of Cardiology, Ospedale San Giovanni, 6500 Bellinzona, Switzerland
2Oncology Institute of Southern Switzerland, 6500 Bellinzona, Switzerland
3Intensive Care Unit, Ospedale San Giovanni, 6500 Bellinzona, Switzerland
Corresponding Author : Marcello Di Valentino
Department of Cardiology, Ospedale San Giovanni, CH - 6500 Bellinzona, Switzerland
Tel: +41 91 811 81 38
E-mail:
[email protected]
Received: June 26, 2015; Accepted: July 13, 2015; Published: July 15, 2015
Citation: Valentino MD, Spataro V, Perren A (2015) A “Swimming” Heart. J Cardiovasc Dis Diagn 3:208. doi:10.4172/2329-9517.1000208
Copyright: © 2015 Di Valentino M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Case

A 61-year-old man was seen by an oncologist for evaluation of a pluri-metastatic pulmonary adenocarcinoma. Thoracic computed tomography, performed two weeks earlier (Figure 1A) showed a left-sided pleural effusion and pericardial metastasis with a small pericardial effusion. During physical examination the patient presented shortness of breath and dizziness. Jugular venous distension, sinus tachycardia (140/min) and pronounced systolic arterial hypotension (70 mmHg) with pulsus paradoxus prompted the suspicion of cardiac tamponade.

In the emergency room a transthoracic echocardiography subcostal view revealed a “swimming” heart with swinging motion due to a huge, relevant pericardial effusion producing diastolic collapse of the free right ventricular wall (Figure 1B).

An urgent needle pericardiocentesis was performed and just 200 ml of sero-hemorrhagic fluid were removed, and signs and symptoms of cardiac tamponade rapidly disappeared. A total of 1200 ml of liquid was progressively evacuated. Repeat echocardiogram revealed no relapse of pericardial effusion, a quasi-voided pericardial space and good diastolic distension of the free right ventricular wall (Figure 2). Consecutively, a pericardiodesis whith cytomicin was affected.

Cardiac tamponade is the accumulation, acute or sub-acute, of pericardial fluid leading to compression of all cardiac chambers due to increased pericardial pressure [1]. Metastatic lung cancer is one of the causes which induce a pericardial hemorrhagic effusion [2].

Although clinical history and physical examination are important elements to suspect cardiac tamponade, the two-dimensional and Doppler echocardiography play major roles in the identification of pericardial effusion and in assessing its hemodynamic significance [3]. In the present case the diagnosis was reached through the interpretation of clinical history and of the clinical signs. The initial suspicion of cardiac tamponade was confirmed by echocardiography, which demonstrates a “swimming” heart into a large pericardial effusion suggesting hemodynamic compromise of the right chamber.
 
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