Myxedema with Massive Pericardial Effusion and Cardiac Temponade

Various cardiovascular disorders associated with myxedema have been called "myxedema heart". The pathogenesis of this condition has been a matter of some disagreement in the literature, but clinical evidence apparently suggests that pericardial effusion occurs frequently and is an important factor accounting for the condition of "myxedema heart". A 61-year-old widow, a rare case of myxedema associated with cardiac tamponade due to massive pericardial effusion is described in this communication. The patient who has been known to have easy fatigue, dyspnea on exertion, cold intolerance, puffy face, sparse hair, hoarseness, hearing loss and slight disorientation for 2 to 25 years developed marked dyspnea and weakness. On admission a chest roentgenogram showed a huge cardiac silhouette and an electrocardiogram revealed generalized low voltage. Cardiac catheterization disclosed the patient having cardiac tamponade due to massive pericardial effusion. Pericardiocentesis relieved her from the tamponade and thyroid replacement therapy reversed the myxedema condition. This case and other 10 cases of myxedema cardiac tamponade in the literature are all saved by pericardiocentesis. The cardiac tamponade of this specific etiology is slow in progress though one of other etiologies is not.