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Paradoxical decrease in blood pressure after relief of cardiac tamponade: the role of sympathetic activity.

Shane B. Rowan, Mori J. Krantz

Med Sci Monit 2006; 12(2): CS16-19

ID: 445248

Background: In contrast to patients who develop acute cardiac tamponadeafter penetrating trauma, tamponade in medical patients may be accompanied by normal or even elevatedsystolic blood pressure. This has been attributed to heightened sympathetic nervous system activity.Case Report: We present a case of a medical patient with simultaneous hypertension and cardiac tamponadewhose blood pressure fell dramatically after pericardiocentesis. We observed a decrease in normetanephrinelevels in our patient concomitant with the decrease in blood pressure. Conclusions: Our case providesfurther support for involvement of the sympathetic nervous system in medical patients with hypertensivetamponade. To our knowledge, this is the first case documenting adrenergic status in a patient with aparadoxical decrease in blood pressure after relief of tamponade.

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