Key result
In a patient with Eisenmenger syndrome and a large pericardial effusion, pericardiocentesis led to spectacular clinical improvement despite the absence of classic signs of cardiac tamponade.
Why the study?
Cardiac tamponade typically presents with classic signs of low cardiac output and elevated jugular venous pressure, but its presentation in Eisenmenger syndrome can be unusual and diagnostically complex.
Case Report (n=1)
No
In patients with Eisenmenger syndrome, classic clinical and echocardiographic signs of cardiac tamponade may be absent due to right ventricular hypertrophy and septal defects, making worsening hypoxia and cyanosis key warning signs requiring pericardiocentesis.
May support pericardiocentesis for large effusions in Eisenmenger syndrome despite absent tamponade signs; hypothesis-generating case requiring confirmation.
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.
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Belkho et al. (2022) conducted a case report in Cardiac Tamponade in Eisenmenger Syndrome (n=1). Pericardiocentesis was evaluated on Clinical improvement. In a patient with Eisenmenger syndrome and a large pericardial effusion, pericardiocentesis led to spectacular clinical improvement despite the absence of classic signs of cardiac tamponade.
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