Cardiac Tamponade in HIV patient

45 year old M with history of HIV/AIDS (CD4 150, VL 18, 000) presents with one week of worsening dyspnea on exertion. One month prior to admission, he was treated with Azithromycin for a productive cough and symptoms of URI. He reports that his baseline is walking on average 5 miles per day while he now can only take a few steps before experiencing SOB. No chest pain or palpitations. He further denies fevers, chills, or night sweats, but does report a 30 pound weight loss over the course of the year.  Further evaluation found him to be febrile, tachypnic and tachycardic now with oxygen requirments. Over the course of the next few days, the patient would undergo a pericardiocentesis for a 3.5cm pericardial effusion found on bedside TTE, with analysis revealing the presence of TB. Additionally, blood studies also revealed a new CD4 count of 11 with a viral load of 180,000.

Highlights of the discussion included the following:

*Broadly, dyspnea on exertion can involve either a cardiovascular, pulmonary, infectious disease or neurological/ psychological process.

* There was the importance of reviewing the etiologies and  pathophysiology of tamponade and its relation to the pericardial pressure-volume curve

* Clinicians being cognizant of various cardiovascular diseases that are commonly seen in a patient with HIV, ranging from cardiomyopathy from Crypto myocarditis to arrhythmias from antivirals.

Enjoy some relevant articles (here and here) to review at your leisure.