Diagnostic Value of Echocardiography in Cardiac Tamponade

Abstract

Cardiac tamponade is a life-threatening condition. Accurate diagnosis and prompt intervention are necessary to prevent adverse outcomes. Clinical features of tamponade such as pulsus paradoxus, tachycardia, elevated jugular venous pressure, and hypotension are important clues to the diagnosis, but are non-specific. Echocardiography allows rapid confirmation of the presence or absence of an effusion, and enables assessment of its hemodynamic impact. Decisions regarding treatment must take into account the clinical presentation and echocardiographic findings. Echocardiographically-guided pericardiocentesis with catheter drainage is the primary treatment strategy of choice for most large or hemodynamically significant effusions. In contemporary clinical practice, echocardiography is the gold standard for diagnosis of tamponade and is essential for directing treatment.

Pericardial Disease

“…2 Echocardiography can also provide information on the significance of the pericardial effusion. 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.…”

“…44 There are other echo-Doppler findings that are indicative of the hemodynamic consequence of cardiac tamponade. 41,45 Distention of the inferior vena cavae that does not diminish with inspiration is a manifestation of the elevated venous pressure in tamponade, 46 whereas venous flow predominantly occurs in systole, not diastole, because of the limited cardiac volume. 47 In addition, there can be marked reciprocal respiratory variation in mitral and tricuspid flow velocities reflecting the enhanced ventricular interdependence that is the mechanism of the paradoxical pulse ( Figure 3).…”

Increased Occurrence of Pericardial Effusion in Patients with Autosomal Dominant Polycystic Kidney Disease

“…CT scan is a well-established method to detect the existence and severity of pericardial effusion (4,19), although it is less sensitive than echocardiography to assess its hemodynamic impact (20). The lack of functional consequences by both the clinical presentation and CT criteria of tamponade physiology in patients with ADPKD and a moderate to large degree of pericardial effusion is consistent with a right shift of the pericardial pressure-volume relation and the passive nature of the fluid accumulation (21).…”

?Tamponade? following cardiac surgery: terminology and echocardiography may both mislead

“…Echocardiography is widely held to be the gold standard in the diagnosis of tamponade [14]. Late following cardiac surgery, where patients present with atypical symptoms or an unexpected low-output state, the condition is often under-diagnosed [15] and TTE is pivotal to the diagnosis.…”