Cardiac tamponade echocardiography

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.D. [2]

Overview

The role of echocardiography in the evaluation of the patient with pericarditis is to chracterize the presence, size, location and hemodynamic impact of a pericardial effusion. Tamponade is characterized by pericardial effusion, diastolic compression of the RV, diastolic compression of the right atrium (RA), plethora of the inferior vena cava and paradoxical septal motion.

Echocardiography

Findings

  • Presence of moderate and large pericardial effusion.
  • Swinging of the heart within the effusion
  • Reversal of right atrial and right ventricular diastolic transmural pressures.
  • Cardiac chamber collapse is a common finding in cardiac tamponade.
  • The right atrium and right ventricle are the most likely to collapse when intrapericardial pressure exceeds intracardiac pressure within any particular chamber.
  • Right atrial collapse
    • Right atrial pressure is minimal during diastole, however, pericardial pressure is maximal in diastole. Due to this fact, the first signs of collapse could be seen during right atrial diastole.
    • A right atrial collapse that persists for > 1/3rd of the cardiac cycle is a good indicator of impending tamponade.
    • Transient right atrial collapse can also occur normally.
  • Diastolic collapse of the right ventricle is a very specific indicator for cardiac tamponade.
  • Diastolic left atrial collapse is a very specific indicator for cardiac tamponade.
  • Left ventricle collapse is uncommon due to the thickness of the ventricular wall.
  • The respiratory variation of inflow and outflow across the mitral and tricuspid valves is increased.
    • Normal respiratory variation in inflow and outflow across the mitral and tricuspid valves ranges between 20 - 25 percent.
    • Mitral valve flow > 35 percent
    • Tricuspid valve flow is 80 to 100 percent.

Pericardial Effusion and Cardiac Tamponade

In pericardial effusion, large hypoechoic regions are seen surrounding the heart with the presence of oscillatory motion of the heart.

The echocardiogram below demonstrates the swinging motion of the heart in cardiac tamponade.


Echocardiography of the heart with loculated pericardial effusion compressing the left ventricle.


Cardiac tamponade


Cardiac tamponade


Left ventricular free wall rupture with cardiac tamponade


Collapse of the right ventricle in a patient with cardiac tamponade


A very large pericardial effusion due to malignancy as seen on cardiac ultrasound. Closed arrow: The heart, open arrow: The effusion


References

  1. Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, Douglas PS, Faxon DP, Gillam LD, Kimball TR, Kussmaul WG, Pearlman AS, Philbrick JT, Rakowski H, Thys DM, Antman EM, Smith SC, Alpert JS, Gregoratos G, Anderson JL, Hiratzka LF, Hunt SA, Fuster V, Jacobs AK, Gibbons RJ, Russell RO (2003). "ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography)". Circulation. 108 (9): 1146–62. doi:10.1161/01.CIR.0000073597.57414.A9. PMID 12952829. Retrieved 2012-09-14. Unknown parameter |month= ignored (help)


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