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 (V_max).

• 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 (Video 2)

• Apical 4C PE mitral inflow Doppler (Video 3)

• Apical4C PE tricuspid inflow Doppler (Video 4)

• PLAX PE swinging heart (Video 5)

CARDIAC TAMPONADE OCCURRING AFTER CARDIAC SURGERY (Video 6)

• If no hypotension, look for

   — Unsuspected hypovolemia

   — Ventricular dysfunction

   — Or LVOT obstruction