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Paradoxical hypertension with cardiac tamponade
Edgar Argulian1, Eyal Herzog, Dan G Halpern
1Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons, New York, New York, USA. eargulian@chpnet.org
The American Journal of Cardiology
|June 23, 2012
Summary
Subacute cardiac tamponade can present with high blood pressure (hypertension). Drainage of pericardial effusion often lowers blood pressure in these hypertensive patients.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Subacute cardiac tamponade typically develops over days to weeks.
- Contrary to common assumptions, subacute tamponade is not always associated with hypotension; many patients present with hypertension.
Purpose of the Study:
- To determine the prevalence and predictors of hypertensive cardiac tamponade.
- To assess the hemodynamic response to pericardial effusion drainage in these patients.
Main Methods:
- Retrospective study of 30 patients with subacute pericardial tamponade undergoing effusion drainage.
- Hypertension defined as initial systolic blood pressure ≥140 mm Hg.
- Echocardiography used to support tamponade diagnosis.
Main Results:
- 27% of patients (8/30) presented with hypertension (mean systolic BP 167 mm Hg).
- Hypertensive patients were more likely to have advanced renal disease and pre-existing hypertension, and less likely to have malignancy.
- Systolic blood pressure significantly decreased after pericardial effusion drainage.
Conclusions:
- Approximately one-third of subacute pericardial tamponade cases exhibit a hypertensive response.
- Pericardial effusion drainage effectively reduces blood pressure in hypertensive patients with cardiac tamponade.
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