Echocardiographie and Doppler Findings in Cardiac Tamponade with Mechanical Alternans

Abstract

We report the Doppler échocardiographie findings in a case of malignant cardiac tamponade. Recording of transmitral inflow velocities showed a predominance of the wave associated with atrial systole and, irregularly, absence of flow. The recording of hepatic vein flow showed a prominent presystolic and systolic wave with a very irregular behavior of the diastolic wave. These data seem to be well related to the hemodynamic pattern typical of cardiac tamponade.

Atrial Tamponade in Malignant Pericarditis: Echocardiographie and Doppler Findings

“…It has been suggested that diastolic right ventricular wall collapse is one of the main mechanisms responsible for pulsus paradoxus [11- vein has been reported in cardiac tamponade [1][2][3] and is related to the hemodynamic pattern of prominent x descent with absence of y descent of the venous pressure waveform [4,5]. Also inspiratory increase of forward hepatic vein flow, as well as of superior vena cava flow [1][2][3]6] has been reported and seems to be related to the marked respiratory variation of right filling typical of car diac tamponade [7], (b) Higher velocities associated with atrial systole of mitral and tricuspidal flows. These find ings have also been reported [2] and are linked to the ele vation of diastolic pressure from the beginning of diastole within the ventricles, which is the reason why ventricles sometimes fill only during atrial systole [8],…”

“…Also inspiratory increase of forward hepatic vein flow, as well as of superior vena cava flow [1][2][3]6] has been reported and seems to be related to the marked respiratory variation of right filling typical of car diac tamponade [7], (b) Higher velocities associated with atrial systole of mitral and tricuspidal flows. These find ings have also been reported [2] and are linked to the ele vation of diastolic pressure from the beginning of diastole within the ventricles, which is the reason why ventricles sometimes fill only during atrial systole [8],…”

“…Reciprocal variations of mitral and tricuspidal veloci ties (i.e., inspiratory increase of transtricuspid and expira tory increase of transmitral flows and vice versa) have also been described in cases of cardiac tamponade [1][2][3]9] and are related to several mechanisms: Me Gregor [7] has reported an exagération of the normal inspiratory in crease in right ventricular filling that impedes left ventric ular filling by causing transient leftward displacement of the interventricular septum. Furthermore, Appleton et al [1] have demonstrated that during inspiration pulmonary wedge pressure falls more than the intrapericardial pres sure, reducing the gradient between the left atrium and the left ventricle in diastole.…”

“…Inspiratory increase of forward flow was also observed. (2) Higher velocities associated with atrial systole of the mitral and tricuspid flows with reciprocal respiratory varia tions, that is, inspiratory increase of transtricuspid and expiratory increase of transmitral flow and vice versa.…”