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Pacemaker leads - Implantable cardiac devices

XII.c

Hemopericardium - Bloody pericardial effusion

Large effusions can cause cardiac tamponade. May occur late into treatment with anticoagulants

Publications

Kumar P, Skrabal J, Frasure SE, Pourmand A

Pacemaker lead related myocardial perforation.

The American journal of emergency medicine 2021 Sep 04;; — 2021 Sep 04

Dudzinski DM, Prabhakar AM, Ptaszek LM, Vlahakes GJ

Case Records of the Massachusetts General Hospital. Case 19-2015. A 71-Year-Old Man with Chest Pain and Shortness of Breath.

The New England journal of medicine 2015 Jun 18;372;2438-46 — 2015 Jun 18 — 2438-46

Liang JJ, Killu AM, Osborn MJ, Jaffe AS

Pacemaker lead perforation causing hemopericardium eight years after implantation.

Indian heart journal 2013 May-Jun;65;331-3 — 2013 May-Jun — 331-3

Ohlow MA, Lauer B, Brunelli M, Geller JC

Incidence and predictors of pericardial effusion after permanent heart rhythm device implantation: prospective evaluation of 968 consecutive patients.

Circulation journal : official journal of the Japanese Circulation Society 2013;77;975-81 — 2013 — 975-81

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

Diagnosing DIRD

Identify causative drugs

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