Abstract

The natural history of pericardial effusions attributable to renal disease is variable. Although aggressive hemodialysis may lead to the resolution of some effusions, some reports suggest that prompt drainage is optimal. We describe a case of a 49-year-old woman who presented with end-stage renal disease and a large pericardial effusion. Although she was hypertensive on presentation and had no pulsus paradoxus, transthoracic echocardiography revealed stigmata of cardiac tamponade, including right atrial and ventricular collapse, as well as a plethoric inferior vena cava. Because of the lack of certain clinical signs of tamponade and due to concern about excess bleeding risk in the setting of uremia, the effusion was initially managed with serial dialysis rather than pericardiocentesis. The effusion did not decrease in size despite 1 week of hemodialysis, and the patient developed acute dyspnea, relative tachycardia and hypotension after an increase in the blood flow rate during hemodialysis, all of which resolved with a decrease in the blood flow rate. The onset of dyspnea during a session of dialysis as a symptom of tamponade physiology has not been reported previously. We believe that this case supports early pericardiocentesis in patients with any degree of echocardiographic evidence of tamponade. We discuss this in the context of existing literature, which suggests that pericardiocentesis, rather than dialysis, is the preferred management strategy for large uremic pericardial effusions, even in the absence of evidence of clinical signs of pericardial tamponade.

Links

Publisher Full Text

Authors

Krantz MJ, Byrd JB

Institution

Division of Cardiology, Department of Medicine, University of Colorado Hospital and Health Sciences Center, Denver, Colo., USA. Mori.Krantz @ dhha.org

Source

Cardiology 120:4 2011 pg 204-8

MeSH

Cardiac Tamponade
Dyspnea
Echocardiography
Female
Humans
Hypotension
Kidney Failure, Chronic
Middle Aged
Pericardial Effusion
Pericardiocentesis
Renal Dialysis
Tachycardia
Ultrasonography, Interventional

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

22286154