Key result
Severe pulmonary arterial hypertension produces atypical cardiac tamponade with isolated diastolic left atrial collapse.
Why the study?
Atypical presentations of cardiac tamponade in severe pulmonary hypertension require detailed characterization to guide diagnosis and management.
Case Report (n=1)
Demonstrates that in patients with severe pulmonary hypertension, cardiac tamponade can present atypically with left atrial collapse and an uncollapsed right atrium due to highly elevated right-sided pressures.
Atypical tamponade signs may occur in severe pulmonary hypertension; this case leaves open whether echocardiographic criteria need modification.
A 33-year-old Caucasian woman with Class 1 idiopathic pulmonary arterial hypertension (PAH) managed on tadalafil, ambrisentan, treprostinil, digoxin and diuretics presented with progressive dyspnoea and orthopnoea since 2 weeks. Cardiac examination revealed hypotension, tachycardia, pulsus paradoxus, jugular venous distension, muffled heart sounds, loud P2 and holosystolic murmur at left-lower sternal border. Transthoracic echocardiogram demonstrated a large circumferential pericardial effusion (PCE) with diastolic left atrial (LA) collapse and uncollapsed right atrium (RA; figures 1 and 2). Severe RA enlargement, severe tricuspid regurgitation, elevated right ventricular (RV) systolic pressure (170 mm Hg) and …
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Vallabhajosyula et al. (2015) conducted a case report in Idiopathic pulmonary arterial hypertension with atypical cardiac tamponade (n=1). A 33-year-old woman with severe pulmonary arterial hypertension presented with atypical cardiac tamponade characterized by diastolic left atrial collapse and an uncollapsed right atrium.
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