Pericardial Tamponade and Limited Cutaneous Systemic Sclerosis

Yebra, Miguel; Astigarraga, B.; Marazuela, Mónica; Lacoma, F.

doi:10.1093/rheumatology/30.2.159

Cited by 9 publications

(4 citation statements)

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“…Sattar et al reported a case of clinically significant, rapid progression of a moderate pericardial effusion to fatal tamponade in a 45-year-old patient with a 10-year history of lcSSc who also had PHTN [ 5 ]. Similarly, Yebra et al described a case of a 57-year-old female with a 16-year history of lcSSc that presented with fevers, chest pain, and friction rub tamponade and recovered without known recurrence [ 6 ]. Nabatian et al reported a case of recurrent pericardial effusion with tamponade in a lcSSc patient without pulmonary or renal involvement, who eventually got a pericardial window [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Hemorrhagic Cardiac Tamponade as a Complication of Limited Cutaneous Systemic Sclerosis

Sami¹,

Sami²,

Tanveer³

et al. 2023

Cureus

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Cardiac tamponade is an uncommon complication of systemic sclerosis (SSc) with a high mortality rate. Here, we report a case of a 58-year-old patient with limited cutaneous systemic sclerosis (lcSSc), gastroesophageal reflux disease (GERD), diabetes mellitus, pulmonary hypertension (PHTN), and COVID-19 infection, which occurred one month ago, presenting with a large hemorrhagic pericardial effusion and early cardiac tamponade. The patient had an acute onset of progressive dyspnea and anasarca. On examination, she was tachypneic, tachycardic, desaturating on room air, and hypotensive. Pitting edema up to thighs and bilateral basilar crackles were also appreciated. Labs were remarkable for negative troponin, chest X-ray with pulmonary congestion, D-dimer at 6.01, CT angiogram negative, brain natriuretic peptide level at 73 pg/mL, C-reactive protein level at 7.64 mg/dL, normal complement levels, and negative COVID-19 test results. Echocardiography showed early tamponade and a large circumferential effusion with chamber collapse. Right heart catheterization was performed finding PHTN at 54 mmHg. Pericardiocentesis drained 500 mL of the hemorrhagic effusion. Fluid analysis showed RBC at 220,000/uL, WBC at 5000/uL, protein 4.8 g/dL, lactate dehydrogenase level of 1275 U/L, and negative cytology. The patient was treated for serositis from lcSSc flare with mycophenolate mofetil and steroids, and responded very well. Hemorrhagic cardiac tamponade is a very rare phenomenon in limited scleroderma. A recent COVID-19 infection could have served as a trigger factor for our patient’s lcSSc in long remission to flare up. Clinicians should maintain a high index of suspicion and a low threshold for intervention when lcSSc patients have an acute onset of cardiac compromise, especially with a history of a recent COVID-19 infection.

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Section: Discussionmentioning

confidence: 99%

Hemorrhagic Cardiac Tamponade as a Complication of Limited Cutaneous Systemic Sclerosis

Sami¹,

Sami²,

Tanveer³

et al. 2023

Cureus

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“…Myocardial fibrosis resulting in heart block is the most common cardiac manifestation in scleroderma patients [13]. While autopsy series have noted pericardial involvement in 50–70% of patients suffering from scleroderma, pericardial involvement rarely manifests itself as pericardial tamponade, with less than 15 cases reported in the English literature [14–23]. After reviewing the records of 210 patients suffering from scleroderma, McWhorter and LeRoy [15] noted two patterns of pericardial disease in a series of 15 patients, namely, acute pericarditis in 4 patients and chronic pericardial effusion with congestive heart failure symptoms in 11 patients.…”

Section: Discussionmentioning

confidence: 99%

Atypical hemodynamic manifestations of cardiac tamponade

Sharma

Panchal

Kalaria

2004

Cathet Cardio Intervent

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Clinical examination and transthoracic echocardiography play a vital role in the management of patients with pericardial effusion and cardiac tamponade physiology. We report patients in advanced phase 3 cardiac tamponade with variant clinical and hemodynamic presentations. These atypical cardiac tamponade cases include: A patient with severe aortic valve regurgitation who lacked pulsus paradoxus; a patient with systemic sclerosis without hypotension; and a patient with pulmonary hypertension lacking right heart collapse on echocardiography. Recognition of these atypical clinical and hemodynamic manifestations of cardiac tamponade will avoid undue delay in the treatment.

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“…Υπερηχογραφικές μελέτες δείχνουν υψηλά ποσοστά υποκλινικής προσβολής του περικαρδίου τόσο σε ασθενείς με περιορισμένη όσο και σε ασθενείς με διάχυτη ΣΣκ(179;224-226). Περιπτώσεις περικαρδιακού επιπωματισμού έχουν περιγραφεί σε περιπτώσεις ασθενών και των δύο υποτύπων ΣΣκ(227)(228)(229)(230)(231). Η επίπτωση της στεφανιαίας νόσου στη ΣΣκ έχει απασχολήσει από παλαιά τη διεθνή βιβλιογραφία.…”

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Η Προσβολή Του Μυοκαρδίου Στη Σκληροδερμία

Plastiras¹,

Πλαστήρας²

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Σκοπός: Να εκτιμηθεί η συχνότητα εμφάνισης και ο τύπος μυοκαρδιακής ίνωσης, όπως εκτιμάται με μαγνητική τομογραφία καρδιάς (MRI) σε ασθενείς με συστηματική σκληροδερμια (ΣΣκ) και να εκτιμηθεί η πιθανή συσχέτιση της ίνωσης με καρδιακές αρρυθμίες. Μέθοδοι: 41 ασθενείς με ΣΣκ υποβλήθησαν σε υπερηχογράφημα καρδιάς, Holter ρυθμού 24ώρου και MRI καρδιάς. Αποτελέσματα: Τεχνικά αποδεκτή MRI καρδιάς επιτεύχθη σε 36 ασθενείς. Ενίσχυση στην MRI συμβατή με ίνωση παρατηρήθηκε σε 24 από τους 36 ασθενείς (66%). Η ίνωση ήταν μεσομυοκαρδιακή με γραμμοειδή τύπο, προσβάλλουσα κυρίως τα βασικά και μέσα τμήματα του μυοκαρδίου της ΑΡ κοιλίας. Ο όγκος της ενίσχυσης δεν διέφερε μεταξύ ασθενών με διάχυτη και περιορισμένη ΣΣκ (P=0.98). Οι ασθενείς με μακρά διάρκεια φαινομένου Raynaud (≥15 έτη) είχαν μεγαλύτερο αριθμό τμημάτων με ενίσχυση (P=0.017) και μεγαλύτερο όγκο ενίσχυσης (P=0.02). 19 ασθενείς (53%) είχαν παθολογική μελέτη Holter και παρουσίαζαν μεγαλύτερο αριθμό τμημάτων με ενίσχυση (P<0.05) και μεγαλύτερο όγκο ενίσχυσης (P<0.05) συγκριτικά με εκείνων που είχαν φυσιλογική μελέτη Holter. Συμπέρασμα: Η MRI καρδιάς ανιχνεύει ίνωση στο μυοκάρδιο σε ένα μεγάλο ποσοστό ασθενών με ΣΣκ και αποτελεί ένα χρήσιμο μη επεμβατικό διαγνωστικό εργαλείο της προσβολής της καρδιάς.

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Pericardial Tamponade and Limited Cutaneous Systemic Sclerosis

Cited by 9 publications

References 0 publications

Hemorrhagic Cardiac Tamponade as a Complication of Limited Cutaneous Systemic Sclerosis

Hemorrhagic Cardiac Tamponade as a Complication of Limited Cutaneous Systemic Sclerosis

Atypical hemodynamic manifestations of cardiac tamponade

Η Προσβολή Του Μυοκαρδίου Στη Σκληροδερμία

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