The circulatory effects produced in a patient with pneumopericardium by artificially varying the intrapericardial pressure

Mechanisms of Edema Formation in Chronic Experimental Pericarditis with Effusion

“…These events in turn catalyze a series of interdependent changes in cardiodynamics and renal function. An elevation in venous pressure is the earliest recorded response to rising intrapericardial pressure, as observed by Cohnheim (39), Starling (40), Kuno (41,42), Katz and Gauchat (37), Beck and associates (43,44) and Fineberg (45) in acute experiments, and by Fletcher (46), Warren and his associates (47,48) and others (49,50) in man. Our data, too, indicate that the venous pressure rise occurs prior to the development of measurable hypervolemia; this confirms the interrelationship between venous and intrapericardial pressures in acute and chronic pericardial tamponade.…”

“…When a critical level of intrapericardial pressure of between 10 to 15 cm. of water is reached, effective filling pressure of the right atrium is markedly reduced (49,50). Resting cardiac output drops and arterial blood pressure falls.…”

Tension pneumopericardium: A rare complication in penetrating chest trauma

“…Adcock et al studied the pneumopericardium in a patient with tuberculous polyserositis and noted that haemodynamic changes only began to be apparent when the intrapericardial pressures reached 145 mm of water (approximately 60 ml of air) and only when pressures reached 265 mm of water did signs of tamponade appear. 1 The classical signs of tamponade can be seen with tension pneumopericardium such as a raised jugular venous pressure (distended neck veins), hypotension, tachycardia, and tachypnoea. On examination a pulsus paradoxus, weakened peripheral pulses, muffled heart sounds and the classically described Mill Wheel murmur (Bruit de Moulin), which is caused by turbulent flow of air and fluid in the pericardial sac, may be present.…”

“…There is a reported mortality rate of 56%, thus rapid diagnosis of TPP and definitive surgical treatment is required. 1 …”

Penumopericardium and tension pneumopericardium after closed-chest injury.

“…The haemodynamic derangements caused by tension pneumopericardium in the presence of multiple injuries requiring resuscitation with large volumes of fluid are difficult to assess. Decreased atrial and ventricular filling, leading to increased central venous pressure and pulsus paradoxus, have been demonstrated during experimental pericardial inflation (Adcock et al, 1940), in pneumopericardium after positive pressure ventilation in hyaline membrane disease (Sagel et al, 1973), and in pneumopericardium as a sequel to subtotal pericardiectomy (Khan, 1974). Adcock et al (1940) showed that when intrapericardial pressure is raised from 145-265 mm water a proportionate rise in venous pressure occurs.…”