Baragé A, Harouna Idrissa S, Mahoungou-Mackonia N, Arous S, Bennouna G, Azzouzi L, Habbal R
Department of Cardiology, IBN ROCHD University Hospital, Casablanca, B.P, 5696, Casablanca, Morocco.
Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, B.P, 5696, Casablanca, Morocco.
Ann Med Surg (Lond). 2021 May 19;66:102410. doi: 10.1016/j.amsu.2021.102410. eCollection 2021 Jun.
The tamponade leads to an increase in intrapericardial pressure, which impairs the diastolic filling of the ventricles and reduces ejection. However, the association with pulmonary arterial hypertension, which in turn leads to an intracardiac hyper-pressure, constitutes a compensatory mechanism. We report the case of a 23 year old patient followed for anemia due to martial deficiency for 2 years, who consulted us with right heart failure evolving for 5 months, a hemoptoic cough and chest tightness. The entire workup revealed a pericardial and pleural tamponade of tuberculous origin associated with a pulmonary embolism evaluated at 15% according to the Qanadli score. After stabilization of her hemodynamic state, the patient was put on anti-bacillary and anticoagulant treatment with a good improvement of her cardiopulmonary state. She was discharged after 1 month (satisfactory check-up), regularly followed up in outpatient clinic with check-up of hemostasis and cardiac echography every 2 weeks. She was declared cured of her tuberculosis after 6 months of treatment. There was no recurrence after two years of follow-up. The combination of tamponade and pulmonary hypertension is synergistic in that it improves the patient's prognosis.
心包填塞导致心包腔内压力升高，这会损害心室的舒张期充盈并减少射血。然而，与肺动脉高压相关联，而肺动脉高压反过来又导致心内高压，这构成了一种代偿机制。我们报告了一例23岁患者，因气血不足导致贫血，随访2年，因右心衰竭进展5个月、咯血性咳嗽和胸闷前来就诊。全面检查显示为结核性心包和胸腔填塞，根据Qanadli评分，合并15%的肺栓塞。在其血流动力学状态稳定后，患者接受抗结核和抗凝治疗，心肺状态有明显改善。1个月后（检查结果满意）出院，定期在门诊随访，每2周检查止血情况和心脏超声。治疗6个月后宣布其结核病治愈。随访两年无复发。心包填塞和肺动脉高压的联合作用具有协同性，可改善患者的预后。
