Acute Pericarditis with Tamponade | Patient Case Quiz

Apr 14, 2015   |  Terence Hill, MD , FACC
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Figure 1: 12 Lead ECG

Fig. 1: 12 Lead ECG

12 Lead ECG shows diffuse ST elevations (most prominent in leads V4-V6, II, aVF) with diffuse PR depressions (most notable in V5-V6) and PR elevation in lead aVR.

Figure 2: Echocardiogram

Fig 2: Echocardiogram

Transthoracic echocardiogram with subcostal window showing right ventricular diastolic collapse (arrows).

Figure 3: Cardiac MRI

Fig 3: Cardiac MRI

Cardiac magnetic resonance image in the sagittal projection with delayed hyperenhancement of the pericardium after gadolinium administration. The markedly increased pericardial signal (arrows) suggests ongoing inflammation.

A 43-year-old woman with a past medical history notable only for tobacco use presented to the hospital with chest pain and dyspnea.

The chest pain was substernal, sharp, pleuritic, and radiated to both shoulders. It had been present for two days but became progressively worse and was associated with dyspnea which prompted her to present for medical attention. She also noted that she had an upper respiratory infection that started about a week before these symptoms began. She had a family history of sarcoidosis but no personal history of any autoimmune disorder.

Initial vital signs were notable for tachycardia at 120 beats per minute. Physical exam was normal and no friction rub was auscultated on exam.

Initial ECG (Fig 1) showed diffuse ST elevations with PR depression and an initial echocardiogram showed a large circumferential pericardial effusion with right ventricular collapse (Fig 2). An erythrocyte sedimentation rate was elevated at 60mm/h.

She underwent urgent pericardiocentesis with removal of 400cc of straw colored fluid. Cytopathology noted many inflammatory cells with no malignant cells. A viral respiratory panel was negative. Cardiac magnetic resonance imaging (Fig 3) after pericardiocentesis suggested ongoing pericardial inflammation.

This patient was treated initially with high dose non-steroidal anti-inflammatory medication and colchicine. Provided the patient responds, how long should the colchicine therapy be continued?

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