From the Guidelines
Early echocardiographic findings of cardiac tamponade include right atrial collapse during late diastole and right ventricular collapse during early diastole, which occur before more severe hemodynamic compromise develops, as recommended by the 2015 ESC guidelines for the diagnosis and management of pericardial diseases 1. These findings are crucial in the diagnosis of cardiac tamponade, as they reflect the pathophysiology of tamponade, where fluid accumulation in the pericardial space increases pericardial pressure, limiting cardiac chamber filling and causing ventricular interdependence. Some key echocardiographic signs of tamponade include:
- Right ventricular collapse during early diastole
- Right atrial collapse during late diastole
- Swinging of the heart within the pericardial space (swinging heart sign)
- Pericardial effusion surrounding the heart
- Doppler studies showing respiratory variation in mitral and tricuspid inflow velocities, with mitral inflow decreasing by more than 25% during inspiration (exaggerated respiratory variation)
- Pulmonary vein flow reversal during atrial contraction These findings are supported by the European Association of Cardiovascular Imaging recommendations for the use of echocardiography in cardiac and cardiac-like emergencies 1, which emphasize the importance of echocardiography in diagnosing cardiac tamponade. The 2015 ESC guidelines for the diagnosis and management of pericardial diseases also recommend urgent pericardiocentesis or cardiac surgery to treat cardiac tamponade 1, highlighting the importance of prompt intervention in patients with cardiac tamponade.
From the Research
Early Echocardiography Findings of Cardiac Tamponade
The early echocardiography findings of cardiac tamponade include:
- Diastolic right ventricular collapse, which has high specificity 2
- Systolic right atrial collapse, considered the earliest sign 2
- A plethoric inferior vena cava with minimal respiratory variation, showing high sensitivity 2
- Exaggerated respiratory cycle changes in mitral and tricuspid valve in-flow velocities, acting as a surrogate for pulsus paradoxus 2
- Early diastolic collapse of the right ventricle 3
- Late diastolic collapse of the right atrium 3
- Respiratory variation in mitral valve inflow, akin to pulsus paradoxus 3
- Decreased early filling (E wave) of mitral valve inflow, related to loss of the y descent 3
Echocardiographic Evaluation
Echocardiographic evaluation of pericardial effusion and cardiac tamponade is crucial for timely and appropriate diagnosis and management 4. A structured echocardiographic approach should include:
- Two-dimensional evaluation
- M-mode evaluation
- Doppler echocardiographic evaluation
- Assessment of the quantity and quality of pericardial fluid
- Assessment of collapse of cardiac chambers
- Assessment of respiratory variation of the ventricular diameters
- Assessment of inferior vena cava collapsibility
- Assessment of flow patterns in atrioventricular valves 4
Importance of Echocardiography
Echocardiography plays a key role in the management of cardiac tamponade and must be consulted with regards to final treatment decisions 5. It enables a clear estimation of the current hemodynamic situation and instant confirmation of the clinical diagnosis of cardiac tamponade 5.