Fatal cardiac tamponade in systemic lupuserythematosus—a hazard of anticoagulation

Leung, Wing‐Hung; Lau, Chu‐Pak; Wong, Cecilia; Leung, C.F.

doi:10.1016/s0002-8703(05)80047-x

Cited by 6 publications

(5 citation statements)

References 6 publications

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“…Rudra et al (16) described 1 patient with an organizing fibrinous pericarditis. Epicardial vasculitis was found at autopsy in another patient who developed hemopericardium during anticoagulation for hemodialysis (23). The histologic findings of fibrosis and/or fibrinous changes in the patients with tamponade described here are similar to those reported among unselected patients in autopsy series, most of whom did not have clinical pericarditis during life (5,9,28).…”

Section: Discussionsupporting

confidence: 78%

“…Most of the reports of tamponade due to SLE are of isolated cases (9,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), which have recently been summarized by Zashin and Lipsky (9) and Reiner and Furie (12). The majority of patients had other manifestations of active SLE and, as in this series, renal disease was noted in approximately half.…”

Section: Discussionmentioning

confidence: 99%

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The spectrum of pericardial tamponade in systemic lupus erythematosus: Report of ten patients

Kahl

1992

Arthritis & Rheumatism

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Objective. To describe the range of clinical manifestations and the outcome of pericardial tamponade in patients with systemic lupus erythematosus (SLE).Methods. Patients with pericarditis and with pericardial tamponade were identified from our computerized database of 395 SLE patients. Medical records were reviewed to establish activity of SLE at the time of tamponade, as well as clinical and laboratory features, treatment, and outcome of the tamponade.Results. Pericarditis occurred in 75 patients (19%), with 11 episodes of tamponade in 10 of them (13%; 2.5% of entire series). Tamponade was the initial manifestation of SLE in 4 patients. Seven episodes occurred during active lupus, with nephritis present in 6. Signs of venous congestion, including ascites and facial or peripheral edema, were the most common manifestation of tamponade. Pericardial fluid was exudative, and pericardial tissue demonstrated a range of findings including fibrinous and fibrotic changes, acute and chronic inflammatory infiltrates, and vascular proliferation. Tamponade was fatal in 1 patient, and 2 patients each had recurrent effusions and pericardial thickening.Conclusion. Pericardial tamponade may occur at any point in the course of SLE, and should be considered in patients with unexplained signs of venous con-

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

The spectrum of pericardial tamponade in systemic lupus erythematosus: Report of ten patients

Kahl

1992

Arthritis & Rheumatism

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“…13 There was 1 patient who had fatal cardiac tamponade presumed to be secondary to anticoagulation and active inflammation in the pericardium. 14 One of the issues present in this case is that the patient had evidence of S pneumoniae from a pleural specimen obtained on admission. In the antibiotic era, purulent pericarditis is very uncommon.…”

Section: Clinical Discussion (Kim a Eagle Md)mentioning

confidence: 96%

“…A few cases of sudden death not due to myocardial infarction have been reported. 13,14 One of them was a patient with both myocarditis and thyroiditis who apparently had myocardial failure and arrhythmias leading to death. 13 There was 1 patient who had fatal cardiac tamponade presumed to be secondary to anticoagulation and active inflammation in the pericardium.…”

Section: Clinical Discussion (Kim a Eagle Md)mentioning

confidence: 99%

Sudden Death in a 55-Year-Old Woman With Systemic Lupus Erythematosus

et al. 1998

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A 55-year-old woman with systemic lupus erythematosus (SLE) and hypertension was admitted for evaluation of a 1-week history of dyspnea and pleuritic chest pain. SLE was diagnosed 3 years ago and manifested as rash, recurrent angioedema, and arthritis. Maintenance therapy with continuous prednisone (10 to 50 mg/d) and briefly with methotrexate for 1 year controlled disease manifestations.Two months before admission, she developed increasing fatigue and malaise. One week before admission, a mild, nonproductive cough and chills were noted. Over the next several days, she developed progressively increasing dyspnea on exertion and bilateral, sharp, anterior chest pain that worsened with inspiration, supine position, and movement.The remainder of the past medical history was notable only for a miscarriage. Family history was unremarkable. The patient was a retired bookkeeper. She had smoked one-half pack of cigarettes per day for 20 years and had 1 alcoholic drink per day. There was no history of illicit drug abuse. Medications at the time of admission were prednisone 10 mg and sustained release nifedipine 60 mg daily. The patient was allergic to penicillin.On physical examination, the patient was in moderate respiratory distress. Blood pressure was 160 to 180 over 90 to 105 mm Hg, heart rate was 120 bpm, respiratory rate was 30 to 40 breaths per minute, and temperature was 99.1°F. The neck veins were flat. Lung sounds were decreased halfway up on the left and one third of the way up on the right. No evidence of consolidation was noted. A loud, 3-component pericardial friction rub was heard. No murmur or gallop was appreciated. A pulsus paradoxus was not present. No active synovitis or joint findings were noted. Pertinent laboratory findings on admission are noted in the Table. The ECG on admission showed sinus tachycardia at 120 bpm. Hospital CourseThe patient was placed on oxygen with a 4-L nasal cannula with an oxygen saturation of 96%. A thoracentesis revealed 672 white blood cells, which were 95% neutrophils, 162 red blood cells, lactate dehydrogenase 805, total protein 5.3, pH 7.39, and Gram stain negative for organisms. She was diagnosed with serositis involving the pericardium and the pleura and placed on intravenous Solu-Medrol every 6 hours. Empiric erythromycin 500 mg IV every 6 hours was initiated.On the second hospital day, a transthoracic echocardiogram revealed a moderate pericardial effusion predominantly surrounding the right atrium without evidence of hemodynamic compromise. Left ventricular hypertrophy, normal chambers and function, and no significant valvular abnormalities were noted. The right ventricular systolic pressure was 40 mm Hg. A repeat thoracentesis was obtained for cell counts and showed 15 250 white blood cells and 5250 red blood cells with 97% neutrophils. The patient's dyspnea and pleuritic chest pain were unchanged. The erythromycin was discontinued. Laboratory evaluation was notable for a positive anticardiolipin antibody. Blood cultures and pleural fluid cytology were negative.On...

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“…One patient with acute pericarditis due to lupus erythematosus had tamponade and died shortly after the initiation of heparin treatment for dialysis. 3 Another patient with rheumatoid arthritis had tamponade after anticoagulant treatment for pulmonary embolism. 4 But we know that often only patients with extremely adverse outcomes are reported in the literature, and we therefore have neither a reliable numerator (the number of patients with serious consequences of anticoagulation) nor a reliable denominator (the total number of patients with acute pericarditis treated with anticoagulants) on which to base a decision.…”

Section: Ommentarymentioning

confidence: 99%

Decision Making by Analogy

Greenberg

Root

1995

N Engl J Med

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In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows.A 27-year-old woman with a history of seizures since childhood was brought to the emergency department because of sharp left anterior pleuritic chest pain, a productive cough, increasingly severe shortness of breath, nausea, and one episode of vomiting. She had no fever, chills, sweats, diarrhea, dysuria, edema, orthopnea, or weight change. She had been ill only one day. The New England Journal of Medicine Downloaded from nejm.org at PRINCETON UNIVERSITY on August 11, 2015. For personal use only. No other uses without permission.

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Fatal cardiac tamponade in systemic lupuserythematosus—a hazard of anticoagulation

Cited by 6 publications

References 6 publications

The spectrum of pericardial tamponade in systemic lupus erythematosus: Report of ten patients

The spectrum of pericardial tamponade in systemic lupus erythematosus: Report of ten patients

Sudden Death in a 55-Year-Old Woman With Systemic Lupus Erythematosus

Decision Making by Analogy

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