Although in SLE pericarditis is pub...

Although in SLE pericarditis is public cardiac tamponade is rare and its usual treatment has been effusion drainage. A 19-year-old girl presenting with cardiac tamponade was diagnosed with SLE Treatment with indomethacin rapidly reduc the hemodynamic compromise, avoiding the ne for pericardiocentesis.

Pericardial involvement is the mostly common cardiovascular manifestation of SLE[12] Pericardial effusion is visit often in lupus pericarditis.[3] However, cardiac tamponade seldom occurs[4] and its incidence has been reported in 08 percent of the combined series.[5] The initial manifestation of SLE as cardiac tamponade is exceptional, if it were not that there have been a small in number anecdotal case reports.[5-10]

We report a patient whose SLE diagnosis was made after an episode of cardiac tamponade that was resolv with indomethacin.

CASE REPORT

A 19-year-old girl was admitted to our hospital with an eight-day history of excitement and anterior chest pain. Previously she had been in religious health except for a mild episode of polyarthralgias single in kind year before admission. Physical examination disclosed tachypnea (28/min), flush (38 [degrees] C) and offspring pressure of 95/60 mm Hg with 30 mm Hg of pulsus paradoxus. A pericardial wipe was heard with softened heart uninjureds The jugular venous squeezing was 10 cm and there was a liver enlargement of 2 cm A chest x-ray film showed cardiomegaly and left pleural effusion. The ECG revealed normal sinus periodical emphasis at 120 beats per minute and electrical alternans (Fig 1) The two-dimensional echocardiogram (Fig 2) showed massive pericardial effusion with right atrial and ventricular diastolic collapse, and M-mode recording (Fig 3) demonstrated important changes in left and right ventricle dimensions during the respiratory circle of time with expiratory collapse of the right ventricle. Significant laboratory values included an erythrocyte sedimentation rate of 89 mm/h; hemoglobin, 9 g/L; hematocrit, 288 percent; white kin cell count, 4,000 cu mm (59 percent neutrophils, 19 percent lymphocyte and 14 percent monocytes); serum iron, 318 [mu]g/dl (57 [mu]mol/L); and Coomb proof negative. Other serum chemistry values were normal. Additional investigations disclosed a fluorescent ANA titer of 1:640 in a homogenous pattern with peripheral reinforcement; anti-DNA antibodies, 117U/L; [Csub3] 074 g/L (normal range, 080 to 170); and [Csub4] 011 g/L (normal range, 015 to 045) Pleural fluid was an exudate with a positive ANA titer of 1:160 and negative bacteriologic investigations. Serologic proofs for virus also were negative.

The diagnoses of SLE and cardiac tamponade were made. Treatment with indomethacin (75 mg daily) was instituted and the hemodynamic compromise was clinically monitored by means of means of heart rate, diuresis, posterity pressure and pulsus paradoxus determinations each four hours. After five days of treatment, excitement and chest pain subsided, progeny pressure was 110/80 mm Hg and paradoxus pulsus had disappeared. Serial echocardiograms showed a progressive reduction of the pericardial fluid. The patient was discharged with a normal echocardiogram and remained asymptomatic during a nine-month follow-up

DISCUSSION

Cardiac lesions involving the endocardium,[11] myocardium[12] and pericardium[13] have been described in SLE Clinically, pericarditis is institute in approximately 25 percent of patients with SLE and necropsy studies display a 70 percent evidence of pericardial involvement.[1-2,5] Pericarditis take places usually during an acute exacerbation of the illness, if it be not that it is rarely the first manifestation. Cardiac tamponade is unusual, and it can be considered extremely rare as the presenting symptom of the disease. Our patient had probably had prior manifestations of SLE in the form of mild transient arthralgia, on the contrary the clinical diagnosis of SLE could sole be made when she was admitted to the hospital with acute pericarditis and cardiac tamponade without other manifestations of the systemic disease.

any authors have advocated for medical treatment with corticosteroids[2,5,14] or other anti-inflammatory drugs[25] in cases of lupus pericarditis, if it were not that all reports of cardiac tamponade in SLE reviewed from the literature required pericardiocentesis or pericardial fenestration.[4,6-10] The evolution of our patient has shown that medical treatment with indomethacin may be an alternative to invasive therapeutic maneuvers in these patients. However, our findings cannot be extrapolated to other cases of cardiac tamponade in SLE as hemodynamics could deteriorate during medical treatment. Therefore, further studies are wanted to support the use of anti-inflammatory physics in the management of SLE cardiac tamponade. Meanwhile, routine management of hemodynamically significant pericardial tamponade should remain pericardial drainage.

REFERENCES

[1] Ansari A, Larson PH Bates HD Cardiovascular manifestations of systemic lupus erythematosus: passing from hand to hand perspective. Prog Cardiovasc Dis 1985; 27:421-34