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Table of Contents
Vol. 120, No. 4, 2011
Issue release date: March 2012
Cardiology 2011;120:204–208
(DOI:10.1159/000335482)

Pericardial Effusion in Renal Disease: To Tap or Not to Tap

Krantz M.J. · Byrd J.B.
aDivision of Cardiology, Department of Medicine, University of Colorado Hospital and Health Sciences Center, and bDivision of Cardiology, Department of Medicine, Denver Health Medical Center, Denver, Colo., USA

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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.



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References

  1. Alpert MA, Ravenscraft MD: Pericardial involvement in end-stage renal disease. Am J Med Sci 2003;325:228–236.
  2. Guberman BA, Fowler NO, Engel PJ, Gueron M, Allen JM: Cardiac tamponade in medical patients. Circulation 1981;64:633–640.
  3. Roy CL, Minor MA, Brookhart MA, Choudhry NK: Does this patient with a pericardial effusion have cardiac tamponade? JAMA 2007;297:1810–1818.
  4. Jardin F, Farcot JC, Boisante L, Prost JF, Gueret P, Bourdarias JP: Mechanism of paradoxic pulse in bronchial asthma. Circulation 1982;66:887–894.
  5. Settle HP Jr, Engel PJ, Fowler NO, et al: Echocardiographic study of the paradoxical arterial pulse in chronic obstructive lung disease. Circulation 1980;62:1297–1307.
  6. Fowler NO: Cardiac tamponade. A clinical or an echocardiographic diagnosis? Circulation 1993;87:1738–1741.
  7. Mercé J, Sagrista-Sauleda J, Permanyer-Miralda G, Evangelista A, Soler-Soler J: Correlation between clinical and Doppler echocardiographic findings in patients with moderate and large pericardial effusion: implications for the diagnosis of cardiac tamponade. Am Heart J 1999;138:759–764.
  8. Banerjee A, Davenport A: Changing patterns of pericardial disease in patients with end-stage renal disease. Hemodial Int 2006;10:249–255.
  9. Rowan SB, Krantz MJ: Paradoxical decrease in blood pressure after relief of cardiac tamponade: the role of sympathetic activity. Med Sci Monit 2006;12:CS16–CS19.
  10. Gill DS, Noarbe MF, Lee RK, Yong QW, Ng KS: Cardiac tamponade associated with an elevated arterial blood pressure. Eur J Intern Med 2005;16:515–517.
  11. Brown J, MacKinnon D, King A, Vanderbush E: Elevated arterial blood pressure in cardiac tamponade. N Engl J Med 1992;327:463–466.
  12. Krantz MJ, Woods JE, Havranek EP, Linas S: Simultaneous malignant hypertension and cardiac tamponade. Am J Kidney Dis 2002;39:E17.
  13. Hoit BD, Shaw D: The paradoxical pulse in tamponade: mechanisms and echocardiographic correlates. Echocardiography 1994;11:477–487.


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