Abstract
Pericardial Decompression Syndrome (PDS) is an uncommon but life-threatening complication
following pericardiocentesis for cardiac tamponade. We report PDS after pericardiocentesis
in two patients that presented to the emergency department with cardiac tamponade.
In both cases, pericardiocentesis was performed under ultrasound guidance using the
left parasternal approach and approximately 1200–1500 mL of pericardial fluid was
removed. Immediately after pericardiocentesis, the haemodynamic status of the patients
improved. However, 2–3 h post decompression, both patients developed hypotension and
pulmonary edema with reduced left ventricular function, suggestive of PDS. PDS is
a condition that is described as paradoxical worsening of vital signs after successful
decompression of the pericardium in the setting of acute tamponade. Three possible
mechanisms explaining PDS are ischaemic, hemodynamic and autonomic processes. If PDS
is unrecognized and untreated, it is associated with a high mortality rate secondary
to pulmonary edema and cardiogenic shock. If managed urgently, the cardiopulmonary
dysfunction in PDS is usually transient and largely reversible with supportive care.
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Article Info
Publication History
Published online: January 15, 2021
Accepted:
January 10,
2021
Received in revised form:
January 9,
2021
Received:
November 23,
2020
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2021 Elsevier Inc. All rights reserved.