Aortic dissection contraindicates pericardiocentesis in card
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A 55-years-old female was presented to the emergency department with acute onset of chest pain irradiating to the back and orthopnea. Of relevant medical history, the patient had a long standing uncontrolled arterial hypertension and diabetes. On admission, the patient’s vital signs revealed asymmetric brachial blood pressure (right arm 95/50 mmHg, left arm: 110/60 mmHg), tachycardia (125 beats/min), and tachypnea (25/min). Examination found external jugular vein distension, hepatojugular reflux, and cold sweaty extremities. Electrocardiography (ECG) showed sinus tachycardia with left ventricular hypertrophy. Transthoracic echocardiography (TTE) revealed large pericardial effusion with signs of hemodynamic compromise, right atrial and ventricular compression, inferior vena cava plethora, and significant flow respiratory variations; it also revealed aortic dilatation and mild central aortic insufficiency. Subsequent chest CT scan displayed type A aortic dissection with pericardial effusion. The patient was transferred to the nearest cardiovascular surgery capable hospital. Unfortunately, the patient died at arrival ...

http://www.edoriumjournals.com/journal-of-case-reports-and-images-in-medicine/archive/2017-archive/100035Z09JO2017-ghalem/100035Z09JO2017-ghalem-full-text.php
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