Chapter 8: Echocardiography in cardiac tamponade

Cardiac tamponade is a clinical diagnosis based on elevated systemic venous pressure, tachycardia, dyspnea, and paradoxical arterial pulse.
Echocardiography allows bedside detection, semiquantitation, and localization of pericardial effusions.
Echocardiography may reveal warningsignsthat suggest tamponade physiology, including right ventricular (RV) and right atrial (RA) collapse, inferior vena cava plethora, and increased transmitral and aortic flow reduction during inspiration.
The duration/severity of collapses and respiratory severity of transmitral and transaortic flow changes are directly related to the severity of tamponade.
Right-sided collapse may be insensitive in RV hypertrophy and high RV intracavitary pressures.
Localized pericardial effusion or clot may occur after cardiac surgery or percutaneous procedures. These “iatrogenic” effusions may be difficult to explore, and off-axis transthoracic echocardiographic views should be used. In cases with poor or inconclusive transthoracic images, transesophageal echocardiography should always be performed.
Percutaneous pericardiocentesis guided by echocardiography is an effective and safe procedure.

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