Sensitivity of Right Atrial Collapse and Right Ventricular Diastolic Collapse in the Diagnosis of Graded Cardiac Tamponade

Abstract

Right atrial collapse (RAC) and right ventricular diastolic collapse (RVDC) have been shown to be useful two-dimensional échocardiographie signs in well-established cardiac tamponade. To assess the value of these signs in cardiac tamponade of varying severity, we studied 8 closed-chest spontaneously breathing dogs with twodimensional echocardiography during varying grades of tamponade induced by intrapericardial saline infusion via a preplaced catheter. Early tamponade was defined as the state when pericardial effusion caused a 20% decline in cardiac output but with normal systolic arterial pressure and a pulsus paradoxus less than 10 mm Hg. Moderate and severe tamponade were stages with progressively decreasing cardiac output and systolic arterial pressure and increasing pulsus paradoxus over 10 mm Hg. Neither RAC nor RVDC was present in any animal in the control state. Sensitivity of RAC was 50% during early tamponade and 100% during moderate and severe tamponade; the specificity was 100% during all grades of tamponade. The sensitivity of RVDC was 38, 63 and 75% during early, moderate and severe tamponade; the specificity was 88% during all stages. Thus, presence of RAC and RVDC in pericardial effusion indicates that hemodynamic deterioration has begun even though conventional signs such as pulsus paradoxus may be absent. As tamponade progresses, the sensitivity of both signs increases. At all grades of tamponade, RAC tends to be more sensitive than RVDC.

Cardiac tamponade complicating trimodal therapy for malignant mesothelioma

“…1 Right ventricular diastolic collapse is sensitive and specific in the diagnosis of tamponade. [3][4][5][6][7] This finding is observed when intrapericardial (in our case intrathoracic) pressure equals, and transiently exceeds, right ventricular diastolic pressure. The two-dimensional echocardiography noted in our patient suggested cardiac tamponade.…”

Anagrelide-Induced Pericardial Effusion in a Patient With Essential Thrombocythemia

“…On the other hand, Rifkin et al states that although sensitivity of RV diastolic collapse increased in relation to the severity of cardiac tamponade, its specificity remained higher and constant at 88% whether the tamponade was early, moderate or severe. RV collapse takes place in early diastole, and as the cardiac tamponade progresses, it could span the entirety of diastole [15][16][17]. Although our patient's echocardiography showed tamponade physiology, the classic beck's triad of muffled heart sounds, presence of JVD, and hypotension did not completely manifest and the patient's only recurrent complaint was shortness of breath requiring minimal oxygen supplementation by nasal cannula.…”

Isolated Left Ventricular Diastolic Collapse in Pericardial Tamponade: An Uncommon Echocardiographic Finding

“…[1][2][3][4] Collapse of cardiac chambers in free pericardial effusion depends on chamber stiffness and transcavitary pressure relationship. Right-sided chambers are thinner and more compliant, and…”

“…[1][2][3][4] Collapse of cardiac chambers in free pericardial effusion depends on chamber stiffness and transcavitary pressure relationship. Right-sided chambers are thinner and more compliant, and thus are prone to collapse compared with the thick and stiff left ventricle that resists collapse in tamponade 5 ; in addition, the normal diastolic pressures of the right atrium (RA) and right ventricle (RV) are lower than those of the LV.…”