Cardiac tamponade and pericardial effusion: Respiratory variation in transvalvular flow velocities studied by Doppler echocardiography

• Published in: Journal of the American College of Cardiology 1988-05, Vol.11 (5), p.1020-1030
• Main Authors: Appleton, Christopher P, Hatle, Liv K, Popp, Richard L
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Blood Flow Velocity; Cardiac Tamponade - physiopathology; Cardiac Tamponade - surgery; Cardiology. Vascular system; Diseases of the pericardium; Echocardiography; Electrocardiography; Evaluation Studies as Topic; Follow-Up Studies; Heart; Heart Valves - physiopathology; Hemodynamics; Humans; Medical sciences; Middle Aged; Pericardial Effusion - physiopathology; Pericardium - surgery; Phonocardiography; Prospective Studies; Pulse; Respiration; Stroke Volume; Vena Cava, Superior - physiopathology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(98)90060-2

Cardiac tamponade has been associated with an abnormally increased respiratory variation in transvalvular blood flow velocities. To determine whether this finding is consistently present in cardiac tamponade, seven patients were studied prospectively with Doppler echocardiography before and after pericardiocentesis and the results were compared with those found in 20 normal adults and 14 asymptomatic patients with pericardial effusion who did not have definite clinical evidence of tamponade. Doppler ultrasound evaluation included measurement of mitral, tricuspid, aortic, pulmonary and central venous flow velocities, as well as left ventricular ejection and isovolumic relaxation times during inspiration, expiration and apnea. In the patients with severe cardiac tamponade, respiratory variation in transvalvular flow velocities and left ventricular ejection and isovolumic relaxation times were markedly increased compared with values in normal subjects and those obtained after pericardiocentesis. In the 14 asymptomatic patients with pericardial effusion but without overt tamponade, 7 showed respiratory variation in flow velocity similar to that of normal subjects. The other seven patients demonstrated increased respiratory change compared with normal, but less than that in the patients with tamponade. Clinical and hemodynamic data in this latter group suggest that these patients may represent an intermediate stage of pericardial effusion with an element of hemodynamic compromise.