The hemodynamic derangement associated with right ventricular diastolic collapse in cardiac tamponade: an experimental echocardiographic study.

Abstract

Clinical reports indicate that right ventricular diastolic collapse (RVDC) is associated with cardiac tamponade. To assess the hemodynamic abnormalities associated with RVDC, we studied six chronically instrumented conscious dogs (group A) with two-dimensional echocardiography during cardiac tamponade induced by continuous saline infusion into the pericardial space. We recorded cardiac output (electromagnetic flowmeter), heart rate, respiration, and aortic, intrapericardial, and right atrial pressures. In four additional animals (group B), we recorded right ventricular pressure and placed a hydraulic occluder around the pulmonary artery so that short-term reversible obstruction to right ventricular outflow could be produced. None of the dogs had RVDC when the pericardial space was empty, but all dogs showed RVDC during cardiac tamponade. The appearance of RVDC in group A was associated with a 21% reduction in cardiac output (p < .01) and no change in mean aortic pressure. Short-term partial pulmonary artery obstruction led to increased right ventricular pressures and a striking reduction in RVDC in early tamponade, suggesting that RVDC is caused by pericardial pressure exceeding right ventricular pressure in early diastole. An additional animal had right ventricular hypertrophy caused by a severe "heart worm" infestation and did not show RVDC during cardiac tamponade. These observations suggest that in the absence of increased resistance to right ventricular outflow or right ventricular hypertrophy, RVDC occurs early in the course of cardiac tamponade and is associated with a hemodynamically important decrease in cardiac output.Circulation 68, No. 3, 612-620, 1983. DETECTION of pericardial effusion was one of the earliest clinical uses of echocardiography,' and the technique has proved to be accurate and extremely sensitive when used for that purpose.2 However, the assessment of the hemodynamic consequences of pericardial effusions by means of echocardiography has been disappointing. M mode echocardiographic findings, including phasic changes in the mitral EF slope,3 right ventricular epicardial systolic notching,4 right ventricular compression,5 and reciprocal alterations in right and left ventricular diameter,6 have been associated with cardiac tamponade but have not achieved

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.…”

Utilidad de la ecografía cardiaca a pie de cama en el manejo del taponamiento cardiaco

“…Si el colapso se extiende hacia el cuerpo del VD, esto sugiere presiones intrapericárdicas muy elevadas (5) . El colapso del VD puede ser atenuado si el VD resiste la compresión debido a hipertrofia o a una enfermedad miocárdica infiltrante (11) o cuando se eleva la presión del VD. Como resultado, el colapso diastólico del VD es más un signo específico más que sensible de taponamiento pericardio (5) .…”

Pattern of Pericardial Disease in the Asir Region of Saudi Arabia

“…Cardiac tamponade was diagnosed when clinical impression was confirmed by the following echo-Doppler criteria: echocardiographic evidence of diastolic collapse of right atrium and right ventricle; 10,11 Doppler ultrasound findings of exaggerated respiratory variation in transvalvar flow velocities; and cross tricuspid, pulmonic and mitral valve. 12,13 Demographic information, presenting symptoms and signs, results of laboratory investigations and outcome were recorded according to a structural flow sheet.…”