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Dialysis-related constrictive pericarditis: old enemies may sometimes come back
Precil Diego Miranda de Menezes Neves1,2, Fábio Cerqueira Lario3, Sara Mohrbacher1
1Hospital Alemão Oswaldo Cruz, Centro de Nefrologia e Diálise, São Paulo, SP, Brasil.
Jornal Brasileiro De Nefrologia
|July 12, 2021
Summary
Sudden hypotension during hemodialysis may indicate constrictive pericarditis in chronic kidney disease patients. Prompt diagnosis and treatment, including pericardiectomy, are crucial for managing this serious complication.
Area of Science:
- Nephrology
- Cardiology
- Pathology
Background:
- Cardiovascular disease is a leading cause of mortality in chronic kidney disease (CKD) patients.
- Pericardial diseases are recognized complications associated with CKD.
- This case highlights Dialysis-related constrictive pericarditis.
Observation:
- A hemodialysis patient presented with sudden severe hypotension, confusion, and malaise.
- Physical examination revealed hypophonetic heart sounds and profound hypotension (50/30mmHg).
- Electrocardiography showed low QRS voltage; echocardiography indicated a thickened pericardium.
Findings:
- Cardiac catheterization confirmed constrictive pericarditis with equalization of diastolic pressures.
- Surgical specimens showed fibrosis and calcification, excluding infection.
- The patient was diagnosed with Dialysis-related constrictive pericarditis.
Implications:
- Sudden, unexplained hypotension in dialysis patients warrants consideration of constrictive pericarditis.
- Early recognition and intervention are vital for improving outcomes in CKD patients with cardiac complications.
- This case underscores the importance of pericardial health monitoring in patients undergoing hemodialysis.
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