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Case Reports
. 2013 Feb 5:2013:bcr2012005281.
doi: 10.1136/bcr-12-2011-5281.

Cardiac tamponade as a presenting manifestation of severe hypothyroidism

Ashvin Butala  1 , Shilpa Chaudhari, Alan Sacerdote
Affiliations
Case Reports

Cardiac tamponade as a presenting manifestation of severe hypothyroidism

Ashvin Butala et al. BMJ Case Rep. .

Abstract

We report a patient who presented to our hospital with unusual symptoms of non-specific complaints and uncontrolled hypertension. Acute cardiac tamponade was suspected from cardiomegaly on routine chest x-ray and confirmed with an echocardiogram. Analysis of the pericardial fluid and other laboratory data ruled out all the common causes except for hypothyroidism as a cause of cardiac tamponade. Tamponade results from increased intrapericardial pressure caused by the accumulation of pericardial fluid. The rapidity of fluid accumulation is a greater factor in the development of tamponade than absolute volume of the effusion. Hypothyroidism is a well-known cause of pericardial effusion. However, tamponade rarely develops owing to a slow rate of accumulation of pericardial fluid. The treatment of hypothyroidic cardiac tamponade is different from other conditions. Thyroxine supplementation is all that is necessary. Rarely, pericardiocentesis is needed in a severely symptomatic patient.

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Figures

Figure 1
Figure 1
Chest x-ray showing cardiomegaly.
Figure 2
Figure 2
Echocardiogram showing diastolic collapse of the right atrium.
Figure 3
Figure 3
Echocardiogram showing diastolic collapse of the right ventricle.
Figure 4
Figure 4
Pulsus paradoxus.
See this image and copyright information in PMC

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