Atypical Cardiac Tamponade Manifesting as Left Ventricular Diastolic Collapse: A Case Report

Shweta Paulraj,Prashanth Ashok Kumar,Robert Voelker,Vijay Raj,Harold Smulyan

doi:10.7759/cureus.8045

Shweta Paulraj, Prashanth Ashok Kumar + Show 3 more

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https://doi.org/10.7759/cureus.8045

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Journal: Cureus	Publication Date: May 10, 2020
License type: cc-by

Affiliation: SUNY Upstate Medical University

Abstract

Cardiac tamponade is a medical emergency, the diagnosis of which is predominantly clinical with supportive echocardiographic findings. Echocardiographic findings highly suggestive of cardiac tamponade include chamber collapse, inferior vena cava (IVC) plethora, and respiratory volume/flow variations. The right-sided cardiac chambers are a low-pressure system and are the first to show signs of collapse with high specificity for tamponade. We report the case of a 35-year-old woman who demonstrated left ventricular (LV) diastolic collapse on echocardiogram following a tricuspid valve replacement. Although left-sided chamber collapse with tamponade has been reported with localized pericardial effusions postoperatively, our patient had a large circumferential pericardial effusion. Selective chamber compression can be a presenting sign of postoperative tamponade after cardiac surgery. Our case highlights the importance of recognizing atypical forms of cardiac tamponade to help in early identification and emergent management in such patients.

Highlights

Cardiac tamponade is a medical emergency that requires timely recognition and treatment [1]
We report the case of a 35-year-old woman who demonstrated left ventricular (LV) diastolic collapse on echocardiogram following a tricuspid valve replacement
We report the case of a patient with cardiac tamponade manifesting as LV diastolic chamber compression on echocardiography

Summary

Introduction

Cardiac tamponade is a medical emergency that requires timely recognition and treatment [1]. A 35-year-old African-American woman with sickle cell disease presented to the hospital with severe, progressive dyspnea and a sickle cell crisis She had a history of severe tricuspid regurgitation and had been previously treated for protein C deficiency, recurrent deep vein thrombosis, and pulmonary emboli with an inferior vena cava (IVC) filter and chronic warfarin therapy. The image shows large circumferential pericardial effusion, predominantly posterior in a location with fibrinous strands (arrow) LA: left atrium; LV: left ventricle. Apical-four chamber view showing large pericardial effusion with diastolic LV apical collapse (arrow). She underwent a subxiphoid pericardial window and placement of a drainage catheter, which led to the removal of 500 cubic centimeters of blood followed by a gradual improvement in her symptoms. A follow-up echocardiogram two months after discharge showed no pericardial effusion (Figure 4)

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