Right ventricular and right atrial collapse in patients with cardiac tamponade--a combined echocardiographic and hemodynamic study.

Abstract

To determine the hemodynamic derangement associated with right ventricular diastolic collapse and to assess the value of right ventricular and right atrial collapse in identifying cardiac tamponade, two-dimensional echocardiograms were recorded simultaneously with measurement of right atrial, pulmonary capillary wedge, intrapericardial, and systemic arterial pressures and cardiac output in 16 patients as they underwent pericardiocentesis. Twelve patients (group I) had evidence of right ventricular or right atrial collapse or both on their echocardiograms and hemodynamic evidence of cardiac tamponade before pericardiocentesis. All hemodynamic parameters improved after pericardiocentesis (p less than or equal to .05). Continuous monitoring during pericardiocentesis in three of these patients showed significant improvement in all parameters except heart rate (p less than or equal to .02) at the point of disappearance of right ventricular diastolic collapse, with further improvement in cardiac output as pericardiocentesis continued (p less than .01). Right atrial collapse persisted after right ventricular collapse disappeared but was no longer present when pericardiocentesis was completed. Three patients (group II) had no right ventricular or right atrial collapse, no hemodynamic evidence of cardiac tamponade, and no improvement in hemodynamic parameters after pericardiocentesis. A single patient (group III) was found to have elevated right heart pressures and right ventricular hypertrophy before pericardiocentesis. Although there was hemodynamic evidence of cardiac tamponade in this patient, there was no evidence of right ventricular or right atrial collapse. In this study, the sensitivity of right ventricular collapse as a marker for cardiac tamponade was 92%, its specificity 100%, its accuracy 94%, and its predictive value 100%.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac tamponade in left ventricular dysfunction.

“…[1][2][3][4][5][6][7][8][9][13][14][15] The present study demonstrates distinctive hemodynamic features and echocardiographic manifestations of experimental cardiac tamponade in the presence of ischemic left ventricular dysfunction. The absence of pulsus paradoxus and the altered manner in which the cardiac chambers are compressed aid our understanding of the pathophysiology of cardiac tamponade and its clinical signs.…”

Pericardial Disease

“…41 In the presence of cardiac tamponade, there is diastolic collapse of the free walls of the right atrium and/or right ventricle. 42,43 This is due to compression of these relatively low-pressure structures by the higher-pressure pericardial effusion. The collapse is exaggerated during expiration when right heart filling is reduced.…”

Management of pericardial effusion by drainage: a survey of 10 years' experience in a city centre general hospital serving a multiracial population

“…A large eVusion with a circumferential echo space of > 1 cm anteriorly or posteriorly is reported to be a powerful predictor of the development of tamponade. 3 Nevertheless, cardiac tamponade is usually a clinical diagnosis which is confirmed by echocardiography, where right ventricular (or right atrial) collapse is usually observed [4][5][6][7] ; however, left ventricular collapse is also seen, especially in the more advanced stages of tamponade, 8 and following cardiac surgery. 9 Rarely, despite life threatening tamponade, right atrial or right ventricular diastolic collapse may not be present in some patients, particularly following cardiac surgery.…”