Cardiac Tamponade in Systemic Sclerosis

Cardiac tamponade is a rare manifestation of systemic sclerosis. We report a man with diffuse systemic sclerosis with a hemorrhagic pericardial effusion who developed cardiac tamponade. He was treated successfully with corticosteroids, subtotal pericardectomy, and methotrexate. While pericardial effusion is common in patients with systemic sclerosis, the development of cardiac tamponade is rare. Cardiac tamponade has been described in patients with diffuse and with limited systemic sclerosis. A literature review uncovered a total of 18 reported cases of cardiac tamponade in patients with systemic sclerosis. An analysis of the patients reported showed no statistically significant differences in the age at presentation or the average duration of disease between men and women who developed cardiac tamponade. Of patients reported, 26% died. Prolonged survival, however, has been associated with more chronic sclero-derma and aggressive treatment with invasive management and corticosteroids. Patients like ours, who are taking anticoagulants, should be screened for the presence of pericardial effusions. The presence of cardiac tamponade should be considered in patients with systemic sclerosis who develop new cardiac failure or compromise.