Hypothyroid cardiac tamponade presenting with severe systemic hypertension

Abstract

Summary:Hemdynamic data are presented which not only depict typical tamponade physiology, but demonstrate that hypotension may not necessarily be present with slow accumulation of pencardial fluid in myxedema patients. This case is unique in that severe hypertension, as part of the presentation of hypothymid tamponade, has never been reported.

Hypertensive Emergency With Cardiac Tamponade Associated With Hypothyroidism

“…Interestingly, the presenting heart rate in the 70s could be interpreted as inappropriate bradycardia, an occasional feature of hypothyroid tamponade 15 . As described, the spectrum of hypothyroid cardiac tamponade has also been associated with severe systemic hypertension at a BP range similar to the present case, 12 as well as very large, slowly accumulating pericardial effusions.…”

“…Cardiac tamponade and massive pericardial effusions rarely occur with severe hypothyroidism and myxedema 12–17 and may be associated with severe systemic hypertension 12,17 . Features of these effusions include large size due to the slow accumulation of up to 6 L of pericardial fluid 13 and relative bradycardia 15 .…”

“…Features of these effusions include large size due to the slow accumulation of up to 6 L of pericardial fluid 13 and relative bradycardia 15 . Hypothyroid status can be associated with diastolic hypertension, but in a patient with hypertensive hypothyroid tamponade presenting with a BP of 210/110 mm Hg, 12 and another patient with hypertensive hypothyroid massive effusion and a BP of 150/100 mm Hg, 17 the hypertension persisted following pericardiocentesis and treatment of the hypothyroid condition. While pericardial effusions may occur in 30%–80% of myxedema patients, echocardiographic surveys in patients with simple hypothyroidism show only a 3%‐6% prevalence of pericardial effusions 18 .…”

“…Our patient had no evidence of pleural effusion or ascites; pericardial tissue pathology did not show evidence of cholesterol crystal‐related inflammation; and echocardiography showed normal cardiac function. Only 20 cases of hypothyroid cardiac tamponade had been reported until 1993, 12 mostly associated with myxedema or severe hypothyroid status and thyrotropins as high as 247.1 mU/L 16 . Massive pericardial effusion in a patient with Hashimoto's thyroiditis and severe systolic/diastolic hypertension requiring an 800‐mL pericardiocentesis has been recorded with a thyrotropin of 38.99 mU/L (normal, 0.24–3.70 mU/L) and a thyroxine of 0.8 μg/dL (normal, 4.5–12.3μg/dL), however, close to the values in the present case discussion; the present patient also had Hashimoto's thyroiditis.…”

Exacerbated Tamponade: Deterioration of Cardiac Function by Lowering Excessive Arterial Pressure in Hypertensive Cardiac Tamponade

“…More grad ual fluid accumulation, 'medical tamponade', permits time for complex cardiocirculatory mechanisms, includ ing increased blood volume, to support systemic arterial pressure for longer periods [1]. Although uncommon, grossly elevated blood pressure despite cardiac tampon ade is well known [3][4][5][6]. Exacerbation of pulsus para doxus by effective antihypertensive therapy has notewor thy physiologic implications.…”