Uremic Pericarditis: When The Kidneys Break The Heart!

The above images represent rapid accumulation of pericardial fluid in the setting uremia. Figure A is a 12-lead electrocardiogram (ECG) with subtle downsloping ST elevation (Spodick’s sign) suggestive of pericarditis. Two-dimensional transthoracic echocardiographic views in the parasternal long axis (Figure B) and apical 4-chamber (Figure C) planes reveal large pericardial effusion with respirophasic compression of the right ventricle (RV) in diastole indicative of cardiac tamponade. The respiratory variation of the tricuspid valve inflow velocities of greater than 40% shown in Figure D is also highly suggestive of cardiac tamponade. Pericardiocentesis and hemodialysis (HD) resulted in resolution of the cardiac tamponade and improvement in the hemodynamic status.