Cardiology Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
Cardiology Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
BMJ Case Rep. 2020 Dec 28;13(12):e238047. doi: 10.1136/bcr-2020-238047.
We describe the case of an 86-year-old man with a background of severe left ventricular dysfunction and ischaemic cardiomyopathy who, having been optimised for heart failure therapy in hospital, unexpectedly deteriorated again with hypotension and progressive renal failure over the course of 2 days. Common causes of decompensation were ruled out and a bedside echocardiogram unexpectedly diagnosed new pericardial effusion with tamponade physiology. The patient underwent urgent pericardiocentesis and 890 mL of haemorrhagic fluid was drained. Common causes for haemopericardium were ruled out, and the spontaneous haemopericardium was thought to be related to introduction of rivaroxaban anticoagulation. The patient made a full recovery and was well 2 months following discharge. This case highlights the challenges of diagnosing cardiac tamponade in the presence of more common disorders that share similar non-specific clinical features. In addition, this case adds to growing evidence that therapy with direct oral anticoagulants can be complicated by spontaneous haemopericardium, especially when coadministered with other agents that affect clotting, renal dysfunction and cytochrome P3A5 inhibitors.
我们描述了一例 86 岁男性病例，他有严重左心室功能障碍和缺血性心肌病病史，在医院接受心力衰竭治疗后得到了优化，但在 2 天的时间里，他再次出现低血压和进行性肾功能衰竭的恶化。排除了常见的失代偿原因，并通过床边超声心动图意外诊断出具有填塞生理学的新的心包积液。患者接受了紧急的心包穿刺术，抽出了 890 毫升血性液体。排除了常见的心包积血原因，自发性心包积血被认为与利伐沙班抗凝的引入有关。患者在出院后 2 个月完全康复。该病例强调了在存在具有相似非特异性临床特征的更常见疾病的情况下诊断心脏压塞的挑战。此外，该病例增加了越来越多的证据表明，直接口服抗凝剂治疗可能会导致自发性心包积血，尤其是当与其他影响凝血、肾功能和细胞色素 P3A5 抑制剂的药物联合使用时。
