Early Tamponade Physiology in a Patient with Autoimmune Disease – A Case Report of Circumferential Pericardial Effusion

Cardiovascular manifestations, such as pericarditis, myocarditis, and thromboembolic events, are well-documented complications in patients with systemic autoimmune diseases that significantly contribute to morbidity and mortality. Nonetheless, early or atypical presentations of cardiac tamponade in patients with overlapping autoimmune conditions remain diagnostically challenging and underreported. We present the case of a 47-year-old woman diagnosed with rheumatoid arthritis (RA), Sjögren’s syndrome (SS), and antiphospholipid syndrome (APS), who was admitted to the emergency department with acute-onset pleuritic chest pain, tachypnea, and hypoxemia. Initial clinical evaluation raised suspicion of pulmonary embolism (PE) due to her prothrombotic risk factors and an elevated D-dimer level of 5 µg/ ml. However, bedside echocardiography identified a moderate-to-large circumferential pericardial effusion with early tamponade physiology, evidenced by respiratory inflow variation and right atrial collapse, despite maintained blood pressure and the absence of classical hemodynamic collapse. Electrocardiography (ECG) revealed sinus tachycardia with electrical alternans. The patient received medical management with high-dose corticosteroids, hydroxychloroquine, and colchicine, along with close hemodynamic monitoring. The patient demonstrated clinical improvement without the need for pericardiocentesis. This case underscores the diagnostic complexities in patients with autoimmune diseases presenting with atypical cardiopulmonary symptoms and highlights the essential role of rapid bedside imaging in detecting occult yet potentially life-threatening complications. Early identification of tamponade physiology, even at low pressure, through point-of-care echocardiography, coupled with targeted anti-inflammatory treatment, is crucial for improving clinical outcomes in patients with systemic autoimmune diseases. Clinicians should maintain a high level of vigilance for cardiac involvement, even in the absence of classical tamponade signs, particularly in patients with multiple, overlapping autoimmune conditions.