Inverse cardiac tamponade in severe pulmonary hypertension

Caravaca Perez, Pedro; Galvan Roman, Francisco; Escribano Subias, Pilar

doi:10.1016/j.medcle.2019.05.022

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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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Vol. 154. Issue 7.

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