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

In contrast to patients who develop acute cardiac tamponade after penetrating trauma, tamponade in medical patients may be accompanied by normal or even elevated systolic blood pressure. This has been attributed to heightened sympathetic nervous system activity. We present a case of a medical patient with simultaneous hypertension and cardiac tamponade whose blood pressure fell dramatically after pericardiocentesis. We observed a decrease in normetanephrine levels in our patient concomitant with the decrease in blood pressure. Our case provides further support for involvement of the sympathetic nervous system in medical patients with hypertensive tamponade. To our knowledge, this is the first case documenting adrenergic status in a patient with a paradoxical decrease in blood pressure after relief of tamponade.