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A Rare Case of Cardiac Tamponade Induced by Chronic Rheumatoid Arthritis.

Yousuf T, Kramer J, Kopiec A, Bulwa Z, Sanyal S, Ziffra J - J Clin Med Res (2015)

Bottom Line: Infectious workup was all found to be negative.Although there has been extensive study of RA, there are only a few documented cases noting the occurrence of cardiac tamponade in these patients.Therefore, it is important for the clinician to be aware of and recognize this potentially serious cardiac outcome associated with a common rheumatologic condition.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine, Advocate Christ Medical Center, Oak Brook, IL, USA.

ABSTRACT
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease primarily involving the joint synovium. RA is a systemic disease which has many known extra-articular manifestations. We present a unique case of a patient with long standing RA who presented with a primary complaint of chest and back pain. Echocardiography revealed borderline normal left ventricular function and a large pericardial effusion with the finding of elevated intrapericardial pressure suspicious for cardiac tamponade. Infectious workup was all found to be negative. The presence and elevation of anti-cyclic citrullinated peptide antibody, rheumatoid factor and C-reactive protein (CRP) confirmed the patient was having an active flare-up of RA. It was determined that this flare-up was the cause of the cardiac tamponade. A pericardiocentesis was performed and 850 mL of bloody fluid was drained. The patient remained stable following the pericardiocentesis. At his follow-up visit, repeat echocardiogram showed no signs for pericardial effusion. Although there has been extensive study of RA, there are only a few documented cases noting the occurrence of cardiac tamponade in these patients. Therefore, it is important for the clinician to be aware of and recognize this potentially serious cardiac outcome associated with a common rheumatologic condition.

No MeSH data available.


Related in: MedlinePlus

Initial echo on January 21, 2015 at 4:38 pm in subcostal view demonstrating large pericardial effusion, pericardial thickening and respiratory variations in the size of the left ventricle and inferior vena cava.
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Figure 2: Initial echo on January 21, 2015 at 4:38 pm in subcostal view demonstrating large pericardial effusion, pericardial thickening and respiratory variations in the size of the left ventricle and inferior vena cava.

Mentions: A 53-year-old Caucasian male was admitted to Advocate Christ Medical Center in January 2015 with multiple complaints including chest and back pain. The patient was diagnosed with RA back in 1989 and was initially treated with prednisolone and non-steroidal anti-inflammatory drugs (NSAIDs). Due to a recent history of perforated abdominal ulcer, his treatment regimen was modified. For the past 5 years, the patient has been on adalimumab and hydroxychloroquine for maintenance therapy of his RA. An electrocardiogram (ECG) (Fig. 1) and cardiac biomarkers were ordered and were found to be unremarkable. A chest X-ray was also performed which was remarkable only for cardiomegaly. In attempts to establish the etiology of the patient’s chest pain, an echocardiogram (echo) was ordered in the emergency department which showed evidence of a large pericardial effusion, pericardial thickening and respiratory variations in the size of the left ventricle and inferior vena cava (Fig. 2). Although the patient was initially stable and well appearing, his chest and back pain began to intensify as the workup was in progress. Therefore, the patient was transferred to the intensive care unit (ICU) to work up the etiology of the effusion. Physical examination in the ICU revealed a pulse of 101, respirations of 21, blood pressure of 120/95 and oxygen saturation of 97% on room air. Jugular venous distention (JVD) was appreciated and no friction rub was noted. Lungs were clear to auscultation and breath sounds were equal and symmetrical bilaterally.


A Rare Case of Cardiac Tamponade Induced by Chronic Rheumatoid Arthritis.

Yousuf T, Kramer J, Kopiec A, Bulwa Z, Sanyal S, Ziffra J - J Clin Med Res (2015)

Initial echo on January 21, 2015 at 4:38 pm in subcostal view demonstrating large pericardial effusion, pericardial thickening and respiratory variations in the size of the left ventricle and inferior vena cava.
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4522992&req=5

Figure 2: Initial echo on January 21, 2015 at 4:38 pm in subcostal view demonstrating large pericardial effusion, pericardial thickening and respiratory variations in the size of the left ventricle and inferior vena cava.
Mentions: A 53-year-old Caucasian male was admitted to Advocate Christ Medical Center in January 2015 with multiple complaints including chest and back pain. The patient was diagnosed with RA back in 1989 and was initially treated with prednisolone and non-steroidal anti-inflammatory drugs (NSAIDs). Due to a recent history of perforated abdominal ulcer, his treatment regimen was modified. For the past 5 years, the patient has been on adalimumab and hydroxychloroquine for maintenance therapy of his RA. An electrocardiogram (ECG) (Fig. 1) and cardiac biomarkers were ordered and were found to be unremarkable. A chest X-ray was also performed which was remarkable only for cardiomegaly. In attempts to establish the etiology of the patient’s chest pain, an echocardiogram (echo) was ordered in the emergency department which showed evidence of a large pericardial effusion, pericardial thickening and respiratory variations in the size of the left ventricle and inferior vena cava (Fig. 2). Although the patient was initially stable and well appearing, his chest and back pain began to intensify as the workup was in progress. Therefore, the patient was transferred to the intensive care unit (ICU) to work up the etiology of the effusion. Physical examination in the ICU revealed a pulse of 101, respirations of 21, blood pressure of 120/95 and oxygen saturation of 97% on room air. Jugular venous distention (JVD) was appreciated and no friction rub was noted. Lungs were clear to auscultation and breath sounds were equal and symmetrical bilaterally.

Bottom Line: Infectious workup was all found to be negative.Although there has been extensive study of RA, there are only a few documented cases noting the occurrence of cardiac tamponade in these patients.Therefore, it is important for the clinician to be aware of and recognize this potentially serious cardiac outcome associated with a common rheumatologic condition.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine, Advocate Christ Medical Center, Oak Brook, IL, USA.

ABSTRACT
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease primarily involving the joint synovium. RA is a systemic disease which has many known extra-articular manifestations. We present a unique case of a patient with long standing RA who presented with a primary complaint of chest and back pain. Echocardiography revealed borderline normal left ventricular function and a large pericardial effusion with the finding of elevated intrapericardial pressure suspicious for cardiac tamponade. Infectious workup was all found to be negative. The presence and elevation of anti-cyclic citrullinated peptide antibody, rheumatoid factor and C-reactive protein (CRP) confirmed the patient was having an active flare-up of RA. It was determined that this flare-up was the cause of the cardiac tamponade. A pericardiocentesis was performed and 850 mL of bloody fluid was drained. The patient remained stable following the pericardiocentesis. At his follow-up visit, repeat echocardiogram showed no signs for pericardial effusion. Although there has been extensive study of RA, there are only a few documented cases noting the occurrence of cardiac tamponade in these patients. Therefore, it is important for the clinician to be aware of and recognize this potentially serious cardiac outcome associated with a common rheumatologic condition.

No MeSH data available.


Related in: MedlinePlus