Tuberculous Pericarditis: How Serious Is It?

Tuberculous pericarditis can become a serious and potentially life-threatening condition if not diagnosed and treated promptly. This form of pericarditis typically arises from a primary tuberculosis (TB) infection, which may spread directly from the trachea, bronchial regions, or mediastinal lymph nodes. Alternatively, it can develop from hematogenous dissemination of primary pulmonary TB or pleural TB infections.

Symptoms and Complications

When tuberculous pericarditis occurs alongside pulmonary TB, patients may experience symptoms such as coughing and hemoptysis (coughing up blood). As the disease progresses, the accumulation of fluid in the pericardial sac—especially when rapid or substantial—can lead to a significant decrease in cardiac output and venous return. This may result in cardiac tamponade, a dangerous condition where the heart is compressed by the excess fluid, impairing its ability to function properly. One of the most common symptoms of this complication is severe dyspnea, or shortness of breath.

Severe Respiratory and Circulatory Symptoms

In advanced stages, patients may adopt a sitting posture to ease breathing, known as orthopnea. They may also display tachypnea (rapid, shallow breathing), pallor, and even cyanosis due to poor oxygenation. Compression of the trachea and esophagus can cause additional symptoms like a dry cough, hoarseness, and difficulty swallowing. Gastrointestinal symptoms such as upper abdominal pain and hepatomegaly (enlarged liver) may also occur, along with systemic signs like generalized edema, pleural effusion, and ascites.

Acute Clinical Presentation

In cases where pericardial effusion develops rapidly, patients may exhibit Beck's triad—a classic clinical sign of cardiac tamponade. Beck's triad includes hypotension (low blood pressure), muffled heart sounds, and jugular venous distention. These patients often present with sinus tachycardia, a narrowing pulse pressure, and significantly elevated venous pressure.

Emergency Management

If cardiac output drops dramatically, acute circulatory failure and shock can occur. In such critical situations, immediate intervention is essential. Pericardiocentesis—a procedure to remove fluid from the pericardial sac—must be performed without delay to relieve pressure on the heart and restore normal hemodynamic function. Failure to act swiftly can result in life-threatening consequences, including death.