title: Paradoxical Hemodynamic Instability After Pericardial Window.
abstract: Paradoxical hemodynamic instability (PHI), also called postoperative low cardiac output syndrome (LCOS), is a rare but fatal complication after drainage of a pericardial effusion (PEf). This condition usually develops within hours postprocedure and appears unrelated to the method of drainage. The exact mechanism of this condition is not well understood. We present a case of an 84-year-old patient with no previous cardiac or cancer history who presented with acute shortness of breath (SOB). Computed tomography (CT) ruled out pulmonary embolism and echocardiography confirmed early tamponade. Following emergent subxiphoid pericardiectomy, the patient developed hemodynamic instability and shock and subsequent multiorgan failure. Repeat echocardiography revealed left ventricular (LV) hypercontractility and new right ventricular (RV) dilatation with akinesis. The patient's condition continued to deteriorate in spite of maximal doses of pressors. The patient died after the family's request to discontinue further extraordinary measures.
authors.affiliation: Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Andrew J
authors.identifier: http://orcid.org/0000-0002-9283-3725
authors.initials: AJ
authors.lastname: Han
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Teresa
authors.initials: T
authors.lastname: Slomka
authors.affiliation: Division of Pulmonary Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Anurag
authors.initials: A
authors.lastname: Mehrotra
authors.affiliation: Division of Pulmonary Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Luis C
authors.initials: LC
authors.lastname: Murillo
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Shadwan F
authors.initials: SF
authors.lastname: Alsafwah
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Rami N
authors.initials: RN
authors.lastname: Khouzam
mesh_terms: D000369:Aged, 80 and over; D002305:Cardiac Tamponade / Q000150:complications / Q000601:surgery*; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D010491:Pericardial Window Techniques / Q000009:adverse effects*; D020519:Pericardiocentesis / Q000009:adverse effects*; D018754:Ventricular Dysfunction / Q000000981:diagnostic imaging* / Q000209:etiology*
keywords: cardiac tamponade; pericardial effusion; pericardial effusion therapy; pericardial window; pericardiocentesis; subxiphoid pericardiectomy