Pericardiocentesis in PH

Q: 47 years old female with history of pulmonary hypertension (PH) is admitted to ICU with chest pain, shortness of breath, and hypoxemia. Bedside Focal Cardiac Ultrasound (FoCUS) showed a large pericardial effusion with tamponade physiology. Which group of PH patients has the highest risk of collapse with bedside pericardiocentesis? - Select one

A) Group 1 - Pulmonary Arterial Hypertension (PAH)

B) Group 2 - PH due to Left Heart Disease 

C) Group 3 - PH due to Lung Diseases and/or Hypoxemia 

D) Group 4 - PH due to Chronic Thromboembolic Disease (CTEPH) 

E) Group 5 - PH with unclear or multifactorial mechanisms 

Answer: A

Overall, all patients with PH are at risk of hemodynamic collapse due to pericardial fluid drainage. Risk is similar to either bedside pericardiocentesis or surgical drainage, but the latter is preferred due to a more controlled environment in the OR. Statistically, the adjusted odds ratio (aOR) for mortality is 1.40, and for postprocedure shock is 1.53.

Patients with pulmonary arterial hypertension (PAH) have been found to have higher mortality rates compared with other non-PAH groups, with aOR 2.35.

#hemodynamics

#pulmonary

References:

1. Vasquez MA, Iskander M, Mustafa M, et al. Pericardiocentesis Outcomes in Patients With Pulmonary Hypertension: A Nationwide Analysis from the United States. Am J Cardiol 2024; 210:232.

2. Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2015; 36:2921.