Paradoxical Hemodynamic Instability After Pericardial Window

Andrew J. Han, Teresa Slomka, Anurag Mehrotra, Luis C. Murillo, Shadwan F. Alsafwah, Rami N. Khouzam

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1251-1252
Number of pages2
Issue number8
StatePublished - Aug 1 2016
Externally publishedYes


  • cardiac tamponade
  • pericardial effusion
  • pericardial effusion therapy
  • pericardial window
  • pericardiocentesis
  • subxiphoid pericardiectomy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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