Progress in Medical Sciences. 2021;
5(1):(46-164)
Subacute Cardiac Tamponade in a Patient with Malignancy
Zohra R. Malik* and Zareen Razaq
Abstract
We hereby present a 57-year-old woman with a history of asthma and hypertension who
presented to the emergency department with shortness of breath, syncope and loss of
consciousness. Patient complained of decreased appetite, constipation and 20lbs weight loss
over one month. Patient denied fever, chills, chest pain, nausea, vomiting, headache, pain or
swelling in lower extremity, trauma, hemoptysis. Vitals at presentation: temperature 99.8 F,
pulse 124 bpm, BP 135/93 mm Hg, respiratory rate 18 pm, oxygen saturation 96% on room
air. Non-contrast CT scan of the brain was unremarkable. Cervical spine CT did not show any
acute bony fracture or subluxation or central canal stenosis. Chest xray showed right upper
lung infiltrate and very small right pleural effusion. Chest CT showed: small pulmonary
emboli involving right lower lobe and left upper lobe sub segmental pulmonary arteries, large
pericardial effusion, right upper lobe ground glass pulmonary infiltrates, right upper lobe
pulmonary mass with multiple bilateral pulmonary nodules concerning for metastatic process,
small right-sided pleural effusion, bilateral hilar and mediastinal lymphadenopathy concerning
for metastatic disease, multiple ill-defined hepatic lesions. EKG showed sinus tachycardia
without electrical alternans. Echocardiogram showed: left ventricular ejection fraction 50-
55%, grade 1 diastolic dysfunction consistent with impaired relaxation and normal filling
pressures. There is a large circumferential pericardial effusion and right ventricular diastolic
collapse suggesting tamponade physiology evident on echocardiogram. Pericardiocentesis
was done, about 700 cc of fluid was removed and the patient’s symptoms improved. This
patient had pericardial effusion most likely due to malignancy. Pericardial fluid buildup and
subsequent tamponade in a malignancy is usually subacute. In malignancy, fluid accumulates
slowly, pericardium stretches with time allowing ample fluid to be accumulated vs in an acute
tamponade as there is very rapid, large pericardial effusion, pericardium does not have time
to stretch and may present with more alarming signs and symptoms. Sub-acute tamponade as
is seen in malignancy presents with less alarming signs and symptoms and might be missed.
Patients with subacute tamponade may be asymptomatic or complain of fatigability, chest
discomfort, dyspnea caused by decreased cardiac output and increased filling pressures
