Pericardial Effusion Leading to Cardiac Tamponade In Hemodialysis Patient: A Challenging

Diagnostic and Management

Background: Cardiac tamponade is a medical emergency when pericardial effusion leads to
decrease in cardiac output and shock. The treatment of choice for pericardial effusions
associated with ESRD poses a difficult challenge in clinical decision making.
Case Illustration and Discussion: A 60‐year‐old woman presented with shortness of breath
worsened by lying flat and activities. The patient also felt sharp chest pain. History of end stage
renal disease on hemodialysis was present. The examination showed a slightly blood pressure
at 90/60, with increased jugular vein pressure, muffled heart sound and ronchi on auscultation
and leg oedema. ECG showed low QRS voltage and x‐ray revealed cardiomegaly with pericardial
effusion. An echocardiogram confirmed the presence of a large pericardial effusion. The next
day she experienced shock, blood pressure 46/28 and cito pericardiocentesis was carried out. A
thousand ml of serohemorrhagic fluid was drained during pericardiocentesis and cytology
examination revealed positive rivalta test with polymorphonuclear cells dominant. Patient felt
her condition improved right after the pericardiocentesis. The management of pericardial
effusion is related to the etiology and initiation of dialysis whether the patient experienced
uremic or dialysis pericarditis. Cardiac tamponade manifesting with dyspnea during a session of
dialysis, illustrates the potential role of early pericardiocentesis in the management of large
pericardial effusions in patients with ESRD.
Conclusion: Cardiac tamponade presenting in hemodialysis requires early diagnosis and proper
treatment to avoid fatal complications.
Keywords: cardiac tamponade, pericardial effusion, hemodialysis, end stage