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Forum Name: Pericardial Diseases

Question: Is Pericardial Tamponade a Possibility?


 Hackettsue - Tue Mar 28, 2006 1:02 pm

I posted a question back in May 2004 regarding my 79 year old mother's sudden death from pericarditis. I have since obtained some additional information that I would like to ask a question about. The pericardial effusion detected in the autopsy was 100cc (which I thought was not enough to cause tamponade). However, it has been pointed out to me that: (1) since the autopsy was done 3 days after her death, all of the pericardial effusion that was there at the time of death may not have been visible by the time the autopsy was actually done, and (2) that since my mother had a markedly enlarged heart as evidenced on the chest x-ray she had taken the day before her death, then a 100cc pericardial effusion could have caused tamponade in her case whereas in a person with a normal size heart, 100cc would not be enough to cause it. Is it possible in her particular case that she did indeed develop pericardial tamponade?
 Dr. A. De la Guerra - Fri May 05, 2006 11:29 pm

User avatar Hi Hackettsue,

I read your previous posts and agree with Dr. Fouad. All heart diseases can lead to sudden cardiac death. Basically, the heart abruptly stops beating due to arrhythmia. The most common causes are coronary heart disease (80-90%) and cardiomyopathies. Unfortunately, sudden death is often the first sign of cardiomyopathy. Current studies demonstrate that sudden cardiac death due to hypertrophic cardiomyopathy is more frequent in older patients than supposed. Such patients may have previously diagnosed heart conditions or not; a common associated disease is hypertension.

Concerning your doubts about the necropsy report, on your first question, the pericardium normally contains 15 to 50cc of fluid. Upon death, enzymes initiate cell decomposition, and 48 hrs later tissues begin to turn into liquids. Also, when the heart stops pumping, fluid builds up in other parts of the body. Although it might be possible that all the effusion may not have been visible (depends on preservation, death cause, etc.), it’s more likely to find extra fluid inside body compartments than fewer with the course of time.

On your second question, the quantity of pericardial fluid needed to cause a cardiac tamponade depends on how fast fluid builds up and on the pericardium compliancy. When accumulation is fast, 150cc could be enough, but it should raise pressure quickly. Non-traumatic situations in which fatal cardiac tamponed might occur by this means is uncommon, and usually are preceded by severe symptoms. Also, when ventricular hypertrophy is present, ventricle is harder to be shrunken by pericardial fluid. In sum, a cardiac tamponade is possible, but rare. Once more I have to agree with Dr. Fouad, I think that the effusion occurred after the heart stopped.

Hope you find this information useful.

Sincerely,

Dr. Alberto de la Guerra.

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