Isolated Left Ventricular Diastolic Collapse in Pericardial Tamponade: An Uncommon Echocardiographic Finding

Abstract

A case of circumferential moderate pericardial effusion causing isolated collapse of left ventricular cavity on two-dimensional echocardiography is reported. Pericardial effusion, mostly of infective etiology, is relatively common in this part of the world. When large enough to cause tamponade, collapse of right atrium, right ventricle, and uncommonly left atrium can be seen. Left ventricular collapse is rare, both due to the larger muscle mass and higher chamber pressure.

Isolated Left Ventricular Diastolic Collapse Due to Extra‐Thoracic Compression

“…1,3 There have been, however, several reports of LV diastolic collapse. In cases of cardiac tamponade, classically, there is collapse of the right atrium (RA), the right ventricle (RV) and, less commonly, the left atrium (LA).…”

“…In cases of cardiac tamponade, classically, there is collapse of the right atrium (RA), the right ventricle (RV) and, less commonly, the left atrium (LA). 1,2 This is due to the low-pressure system in the right side of the heart, as well as the mechanical properties of the right-sided chambers compared with those on the left (less muscle mass, more compliance). 1,3 There have been, however, several reports of LV diastolic collapse.…”

“…1,2 This is due to the low-pressure system in the right side of the heart, as well as the mechanical properties of the right-sided chambers compared with those on the left (less muscle mass, more compliance). 1,3 There have been, however, several reports of LV diastolic collapse. These were usually noted postoperatively due to pericardial fluid or hematoma.…”

“…These were usually noted postoperatively due to pericardial fluid or hematoma. 1,4,5 In nonsurgical cases, the LV collapse due to a moderate pericardial effusion occurred in the presence of severe pulmonary hypertension and RV pressure overload, rendering the right side of the heart less collapsible. 3,6 In an experimental study, a gradual increase in intraabdominal pressure (IAP) up to 15 mmHg did not result in any significant change in left ventricular end-diastolic transmural pressure (LVEDTP) and, thus, cardiac output, left ventricular end-diastolic area (LVEDA), and left ventricular end-diastolic pressure (LVEDP) remained stable.…”