Pericardial Decompression Syndrome

Pericardial decompression syndrome is a rare but potentially life-threatening complication of pericardiocentesis. It is characterized by myocardial dysfunction that leads to hemodynamic instability and acute heart failure. A 24-year-old woman was admitted for a large malignant pericardial effusion. After drainage of this effusion, she had hemodynamic instability, with severe right ventricular dysfunction and impaired left ventricular filling. Spontaneous improvement was seen after 10 days of supportive care. The exact pathophysiology behind this condition is not well understood, however this case highlights the impact that right ventricular dilation can have on left ventricular filling and cardiac output. Pericardial decompression syndrome is a rare but life-threatening complication of pericardial drainage. A slower drainage approach is recommended for large effusions.