Hydralazine-Associated Pericardial Effusion Causing Cardiac Tamponade Without Hypotension.

Oluwakorede Akele, Zade Bihag, Tara Raj, Vaibhav Satija, Aaradhana Kaul, Martha Radford, Juyong Lee

Abstract readCase Reports

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Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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7 authors.

Oluwakorede AkeleDepartment of Medicine, University of Connecticut School of Medicine, UConn Health, Farmington, Connecticut, USA.

Zade BihagDepartment of Cardiovascular Medicine, University of Connecticut School of Medicine, Calhoun Cardiovascular Center, UConn Health, Farmington, Connecticut, USA.

Tara RajDepartment of Rheumatology, University of Connecticut School of Medicine, UConn Health, Farmington, Connecticut, USA.

Vaibhav SatijaDepartment of Cardiovascular Medicine, University of Connecticut School of Medicine, Calhoun Cardiovascular Center, UConn Health, Farmington, Connecticut, USA.

Aaradhana KaulDepartment of Rheumatology, University of Connecticut School of Medicine, UConn Health, Farmington, Connecticut, USA.

Martha RadfordDepartment of Cardiovascular Medicine, University of Connecticut School of Medicine, Calhoun Cardiovascular Center, UConn Health, Farmington, Connecticut, USA.

Juyong LeeDepartment of Cardiovascular Medicine, University of Connecticut School of Medicine, Calhoun Cardiovascular Center, UConn Health, Farmington, Connecticut, USA. Electronic address: jlee@uchc.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDrug-induced pericardial effusion is an uncommon but clinically significant cause of cardiac tamponade. Hydralazine is strongly associated with autoimmune phenomena, yet cardiovascular manifestations remain under-recognized. CASE SUMMARY: A 42-year-old man receiving high-dose hydralazine presented with progressive dyspnea, dizziness, and palpitations. Transthoracic echocardiography demonstrated a large circumferential pericardial effusion with right ventricular diastolic collapse and a plethoric inferior vena cava, consistent with tamponade physiology despite preserved blood pressure. Emergent pericardiocentesis drained 1,860 mL of serosanguinous exudative fluid, with immediate symptom relief. Serologic testing revealed antinuclear antibody positivity, markedly elevated perinuclear antineutrophil cytoplasmic antibodies, and borderline myeloperoxidase antibodies. Hydralazine withdrawal and corticosteroid therapy resulted in sustained clinical and echocardiographic resolution. DISCUSSION: This case highlights hydralazine as a reversible cause of autoimmune-mediated pericardial effusion and illustrates that tamponade may occur without hypotension. TAKE-HOME MESSAGES: Medication-induced autoimmunity should be considered in unexplained pericardial effusions. Early recognition and drug withdrawal can prevent life-threatening complications.

Indexed as

ANCA-associated vasculitiscardiac tamponadedrug-induced serositishydralazine-induced autoimmunitypericardial inflammation

Identifiers

PMID41837937

DOI10.1016/j.jaccas.2026.107284

PMCPMC13112589

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