Cardiac Tamponade in Eisenmenger Syndrome: A Diagnosing Complexity: Case Report

Abstract

Cardiac tamponade is a form of obstructive shock with clinical manifestations consistent with a low cardiac output and high central venous pressure. Features of a low cardiac output include low mean arterial pressure, cold peripheries and signs of poor end-organ perfusion. Characteristically, palpating the pulse reveals an apparent variation in pulse volume because of pulsus paradoxus. Jugular venous pressure is typically increased, with distended neck veins apparent. Sympathetic tone is increased in an attempt to compensate for the low cardiac output and manifests as tachycardia, diaphoresis, anxiety [1] and poor distal perfusion determining the need for emergent Pericardiocentesis. We report a case where an hemodynamically significant pericardial effusion with indication of pericardiocentesis had presented without classic signs of tamponade. It is an unusual and rare case of large pericardial effusion in the setting of Eisenmenger syndrome where only clinical signs as worsening hypoxia and cyanosis due to the right to left shunt was the warning sign of cardiac tamponade requiring pericardiocentesis.