Subacute Cardiac Tamponade With Massive Pericardial Effusion

Area of Science:

• Cardiology
• Internal Medicine
• Diagnostic Imaging

Background:

• Subacute cardiac tamponade presents with non-specific symptoms, making early diagnosis difficult.
• The onset and severity of cardiac tamponade depend on the rate of pericardial fluid accumulation and the pericardium's elasticity.
• Unlike acute cardiac tamponade, subacute cases without cardiac arrest pose challenges in deciding on urgent drainage.

Observation:

• A 40-year-old male presented with a 7-day history of shortness of breath.
• Initial chest X-ray revealed a large cardiac silhouette suggestive of pericardial effusion; ECG showed minor QRS variations.
• Point-of-care and urgent departmental echocardiography confirmed massive pericardial effusion with subacute tamponade features.

Findings:

• Approximately 4.2 liters of pericardial effusion were drained via cardiac catheterization.
• Pericardial fluid analysis, connective tissue disease screening, CT scans, and COVID-19 testing were negative for infection or malignancy.
• The patient experienced rapid symptomatic improvement post-drainage with an uneventful recovery.

Implications:

• This case highlights the diagnostic challenge of subacute cardiac tamponade due to non-specific symptoms.
• Echocardiography is vital for assessing pericardial effusion and guiding management decisions in suspected cardiac tamponade.
• Idiopathic or subclinical viral causes are likely for massive pericardial effusion leading to subacute cardiac tamponade.