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She was admitted due to congestive heart failure. The echocardiogram showed right ventricular (RV) dilatation, systolic dysfunction, severe PH and severe pericardial effusion around the left ventricle (LV) of up to 25mm with signs of cardiac tamponade (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>): collapse of left cavities without involvement of right cavities with hemodynamic compromise (significant variability of intracavitary flows).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Conservative management was chosen due to the terminal condition of the disease and the difficult percutaneous approach to perform a pericardiocentesis. Diuretic treatment was intensified to relieve congestion and corticosteroids to treat the associated serositis component. She showed good progression with remission of congestive symptoms and echocardiographic tamponade signs. The videos (<a class="elsevierStyleCrossRef" href="#sec0050">Annex. Additional material</a>) show that the LV has a reduced cavity with loss of its usual geometry with pericardial effusion around it, resulting in partial collapse of both the left atrium and the LV.The pathophysiological findings are justified by the significant right chamber pressure increase due to the presence of severe PH and RV dilatation. The good response to treatment with diuretic therapy with the aim of alleviating exaggerated ventricular interdependence due to RV failure, thus favouring LV filling, should be highlighted.FundingWork funded by the Carlos III Health Institute (Ministry of Economy, Industry and Competitiveness) and co-financed by the European Regional Development Fund, through the CIBER of Cardiovascular Diseases (CB16/11/00502)." 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ISSN: 2387-0206

Launched in 1943, Medicina Clínica is a fortnightly journal aimed at the promotion of clinical research and practice among internal medicine and other specialists. The key characteristics of Medicina Clínica are the scientific and methodological rigor of its manuscripts, the topicality of its contents, and, especially, its practical focus with highly useful information for clinical practice. Medicina Clínica is predominantly interested in publishing original research manuscripts, which are rigorously selected according to their quality, originality, and interest, and also in continued medical education-oriented manuscripts, which are commissioned by the journal to relevant authors (Editorials, Reviews, and Diagnosis and Treatment). These manuscripts contain updated topics with a major clinical or conceptual relevance in modern medicine. The journal adheres to the standards of academic research publications in all aspects including peer-review and ethical principles. Medicina Clínica is included in the General and Internal Medicine category of Thomson Reuters.

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