Recognition of Cardiac Tamponade in the Presence of Severe Pulmonary Hypertension
Authors: Martin J. Frey
Journal: Annals of Internal Medicine (1989)

Brief Reports1 October 1989Recognition of Cardiac Tamponade in the Presence of Severe Pulmonary HypertensionMartin J. Frey, MD, Barbara Berko, MD, Harold Palevsky, MD, John W. Hirshfeld Jr., MD, Howard C. Herrmann, MDMartin J. Frey, MD, Barbara Berko, MD, Harold Palevsky, MD, John W. Hirshfeld Jr., MD, Howard C. Herrmann, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-111-7-615 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe clinical features of cardiac tamponade in a patient with a pericardial effusion may include dyspnea, elevated systemic venous pressure, and pulsus paradoxus. Right ventricular diastolic collapse (RVDC) on M-mode or two-dimensional echocardiography is an early and sensitive sign providing additional evidence for the diagnosis of tamponade (1). The hemodynamic observations of elevated and equal diastolic pressures in all cardiac chambers, hypotension, and a decreased cardiac output that return to normal after removal of the effusion confirm the diagnosis (2). However, the clinical recognition of cardiac tamponade in patients with pulmonary hypertension is more difficult. These patients typically have elevated...References1. Armstrong W, Schilt B, Helper D, Dillon J, and Feigenbaum H. Diastolic collapse of the right ventricle with cardiac tamponade: an echocardiographic study. Circulation. 1982;65:1491-6. CrossrefMedlineGoogle Scholar2. Reddy P, Ciertess E, O'Toole J, and Shaver J. Cardiac tamponade: hemodynamic observations in man. Circulation. 1978;58:265-72. CrossrefMedlineGoogle Scholar3. Boltwood C. Ventricular performance related to filling pressure in clinical cardiac tamponade. Circulation. 1987;75:941-55. CrossrefMedlineGoogle Scholar4. Leimgruber P, Klopfenstein H, Wann L, and Brooks H. The hemodynamic derangement associated with right ventricular diastolic collapse in cardiac tamponade: an experimental echocardiographic study. Circulation. 1983;68:612-20. CrossrefMedlineGoogle Scholar5. Singh S, Wann L, and Schuchard G. Right ventricular and right atrial collapse in patients with cardiac tamponade-a combined echocardiographic and hemodynamic study. Circulation. 1984;70:966-71. CrossrefMedlineGoogle Scholar6. Klopfenstein H, Schuchard G, and Wann L. The relative merits of pulsus paradoxus and right ventricular diastolic collapse in the early detection of cardiac tamponade: an experimental echocardiographic study. Circulation. 1985;71:829-33. CrossrefMedlineGoogle Scholar7. Cogswell T, Bernath G, Wann L, Hoffman R, Brooks H, and Klopfenstein H. Effects of intravascular volume state on the value of pulsus paradoxus and right ventricular diastolic collapse in predicting cardiac tamponade. Circulation. 1985;72:1076-80. CrossrefMedlineGoogle Scholar8. Shabetai R. Changing concepts of cardiac tamponade [Editorial]. J Am Coll Cardiol. 1988;12:194-5. CrossrefMedlineGoogle Scholar9. Kronzon I, Cohen M, and Winer H. Cardiac tamponade by loculated pericardial hematoma: limitations of M-mode echocardiography. J Am Coll Cardiol. 1983;1:913-5. CrossrefMedlineGoogle Scholar10. Fowler N, Gabel M, and Buncher C. Cardiac tamponade: a comparison of right versus left heart compression. J Am Coll Cardiol. 1988;12:187-93. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Martin J. Frey, MD; Barbara Berko, MD; Harold Palevsky, MD; John W. HirshfeldJr., MD; Howard C. Herrmann, MDFrom the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. For current author addresses, see end of text. 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