Echocardiography for cardiac tamponade.

INTRODUCTION

Cardiac tamponade refers to the haemodynamic that occurs when the pressure within a pericardia} effusion compresses the heart. (Video 1)

It is a clinical diagnosis indicated by the presence of:

— Breathlessness (with clear lungs)

— Tachycardia (>100 beats/min)

— Pulsus parasoxus (>10mmHg fal in systolic blood pressure during inspiration)

TYPES OF TAMPONADE (Fig. 1)

Acute tamponade

Chronic tamponade

PERICARDIAL TAMPONADE

Acute pericardia tamponade diastolic collapse of the right ventricle is noted on subxiphoid view. (Fig. 2)

PWD IN APICAL 4CHAMBER VIEW & PSAX (Fig. 3)

PWD in the apical 4-chamber view to interrogate tricuspid and mitral inflow.

PW Doppler in the parasternal short axis view to interrogate RVOT flow and record both the velocity time integral (VTI) and peak velocity (Vmax).

The normal respiratory variability in both is <10 percent, but is greater in the presence of tamponade.

IVC is dilated with absent inspiratory collapse.

MASSIVE PERICARDIAL EFFUSION – THE SWINGING HEART

Apical 4C PE swinging heart (

Apical 4C PE mitral inflow Doppler (

Apical4C PE tricuspid inflow Doppler (

PLAX PE swinging heart (

CARDIAC TAMPONADE OCCURRING AFTER CARDIAC SURGERY (Video 6)

If no hypotension, look for

— Unsuspected hypovolemia

— Ventricular dysfunction

— Or LVOT obstruction