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Causes of Recurrent Cardiac Tamponade

Hi, I am doctor Rizwan Rauf.
My father got cardiac tamponade for the 2nd time. He is 53, non-smoker, non-diabetic, non-hypertensive , no H/O fever, wt. loss, never hospitalized, never got TB.
4 months ago, he got tamponade for the first time without any precious alarming signs. He was in a car, suddenly got perspiration and low BP. On examination, JVP was raised. So, symptomatic treatment was given and he got better. No diagnostic tap was done. Two weeks after diuretics ( spiromide 40---BD), echo was normal ,without any pericardial effusion. EF and BiVentricular fuction was normal. We considered it as viral, so further workup was done.
Two months after 1st attack, he again got spontaneous tamponade. Low BP and High JVP. Echo showed massive effusion. 25mm posteriorly, 15mm anteriorly, and 20mm at the apex. So it was decided to tap it. On aspiration under fluoroscopy, 800 ml, hemorrhagic fluid was obtained. At first sight we considered it as malignant. But results form 2 reputable Labs showed LDH >1000. Glucose and protein at low level. No Malignant cells, Zn stain for AFB –ve. Culture after 8 weeks also -VE.
So, after consultation we stated ATT ( MYRIN-P Fort), 5 tablets according to body wt. i.e 72 kg.
One month after ATT echo was normal , without any pericardial effusion.
But yesterday, after 9 weeks of ATT 10mm effusion is found anteriorly and 13mm posteriorly, with out any symptoms.
This is very critical situation for me. Whether our diagnose is not correct. Or ATT is not responding. Or it is responding ? , as last time it was massive effusion without any treatment. But this time 9 weeks after ATT , effusion is mild.
May there is malignancy any where.
Chest X-Ray is clear for any lung pathology.
ESR is normal. LFT , RFT are normal. Interestingly he gained 3 kg wt. and now he is 75 kg , as compared to 72 before ATT.
Please help me out to solve the problem.
Why there is again accumulation.
How to proceed further.
Continue ATT or hold it.
Any Qs, to be asked, please ask me.
Looking forward to hearing form you
Thanks
With Regards,
Dr. Rizwan Rauf
drrizwanrauf@yahoo.com
Asked On : Tue, 8 Feb 2011
Answers:  1 Views:  194
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General & Family Physician 's  Response
hi dear ,its better to check the reistance ti INH AND RIFAMPACIN AND IF SO CONSIDER SECONDLINNE THERAPY ,MOREVER WHETHER PCR DONE FOR MYCOBACTER OR NOT AND HISTORY IS NOT SUGGESTIVE OF ANY DISEMINATED MALIGNANCY BUT CT CHEST IS AN OPTION SECONDLY AFTER TESTING THE ATT.
TC
Answered: Sun, 14 Aug 2011
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