Acute heart failure following decompression of tuberculosis induced pericardial tamponade

Summary 

Acute heart failure following pericardial decompression is a potentially fatal complication. We present a case with tuberculosis induced cardiac tamponade. After the emergent drainage of the pericardial cavity the patient remained hemodynamic unstable. Echocardiography revealed global biventricular systolic dysfunction and low cardiac output. Inotropic support was initiated and the patient gradually improved. Possible mechanisms implicated in this complication are the interventricular volume mismatch after the release of pericardial constraint in the presence of vasoconstriction due to high catecholamine levels or an acute increase in “wall stress” due to the acute distension of the cardiac chambers. Also systolic dysfunction may be already present but masked by the reduced chamber sizes and the tachycardia during tamponade. Physicians must be aware of this complication.

Keywords: Cardiac tamponade, Tuberculosis, Stunning myocardium

Abbreviations: ICU, Intensive Care Unit, LVEF, Left ventricular ejection fraction, LV, Left ventricular, RT, Right ventricular, TB, Tuberculosis