Author(s): Ahmed M Shafter
Minoxidil is a powerful antihypertensive medication that has been used extensively to control blood pressure in patients with renal failure. Its mechanism of action is through a cyclic AMP-mediated effect on arteriolar smooth muscle, with little effect on veins causing a direct vasodilatation of peripheral blood vessels. Minoxidil use has been associated with cause and/or exacerbation of pericardial effusions both in dialysis patients and those with normal kidney function. We report a 58-year-old African American female with history of severe resistant hypertension that has been controlled by Minoxidil 5 mg po BID, and stage 3 chronic kidney disease who presented with shortness of breath, and headache. Blood pressure 240/124 mmHg. Her CT Brain revealed no intracranial bleed. Electrocardiogram showed normal sinus rhythm, with no ST/T wave changes. Cardiac biomarkers were normal. However, 2D Echocardiogram showed Estimated ejection fraction EF of 65%, moderate pericardial effusion, with no evidence of pericardial tamponade, and moderate Left ventricular hypertrophy. This case reviews and explains the association between Minoxidil use and pericardial effusion, which may need appropriate treatment/monitoring, and extensive work ups to rule out other pathologies.
