JACC. Case reports · 2026
Hydralazine-Associated Pericardial Effusion Causing Cardiac Tamponade Without Hypotension.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Akele Oluwakorede, Bihag Zade, Raj Tara, Satija Vaibhav, Kaul Aaradhana, Radford Martha, Lee Juyong
Аннотация
BACKGROUND: Drug-induced pericardial effusion is an uncommon but clinically significant cause of cardiac tamponade. Hydralazine is strongly associated with autoimmune phenomena, yet cardiovascular manifestations remain under-recognized.
CASE SUMMARY: A 42-year-old man receiving high-dose hydralazine presented with progressive dyspnea, dizziness, and palpitations. Transthoracic echocardiography demonstrated a large circumferential pericardial effusion with right ventricular diastolic collapse and a plethoric inferior vena cava, consistent with tamponade physiology despite preserved blood pressure. Emergent pericardiocentesis drained 1,860 mL of serosanguinous exudative fluid, with immediate symptom relief. Serologic testing revealed antinuclear antibody positivity, markedly elevated perinuclear antineutrophil cytoplasmic antibodies, and borderline myeloperoxidase antibodies. Hydralazine withdrawal and corticosteroid therapy resulted in sustained clinical and echocardiographic resolution.
DISCUSSION: This case highlights hydralazine as a reversible cause of autoimmune-mediated pericardial effusion and illustrates that tamponade may occur without hypotension.
TAKE-HOME MESSAGES: Medication-induced autoimmunity should be considered in unexplained pericardial effusions. Early recognition and drug withdrawal can prevent life-threatening complications.
CASE SUMMARY: A 42-year-old man receiving high-dose hydralazine presented with progressive dyspnea, dizziness, and palpitations. Transthoracic echocardiography demonstrated a large circumferential pericardial effusion with right ventricular diastolic collapse and a plethoric inferior vena cava, consistent with tamponade physiology despite preserved blood pressure. Emergent pericardiocentesis drained 1,860 mL of serosanguinous exudative fluid, with immediate symptom relief. Serologic testing revealed antinuclear antibody positivity, markedly elevated perinuclear antineutrophil cytoplasmic antibodies, and borderline myeloperoxidase antibodies. Hydralazine withdrawal and corticosteroid therapy resulted in sustained clinical and echocardiographic resolution.
DISCUSSION: This case highlights hydralazine as a reversible cause of autoimmune-mediated pericardial effusion and illustrates that tamponade may occur without hypotension.
TAKE-HOME MESSAGES: Medication-induced autoimmunity should be considered in unexplained pericardial effusions. Early recognition and drug withdrawal can prevent life-threatening complications.