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(Circulation. 1974;50:260.)
© 1974 American Heart Association, Inc.

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The Electrocardiographic Features of Acute Cardiac Tamponade

HOWARD S. FRIEDMAN M.D.¹; JOSEPH A. GOMES M.D.¹; ANTHONY R. TARDIO M.D.¹; JACOB I. HAFT M.D.¹

¹ From the Cardiac Section of the Bronx VA Hospital and Mount Sinai School of Medicine, New York, New York.

To test the hypothesis that the electrocardiogram of cardiac rupture is due to acute cardiac tamponade, 27 episodes of cardiac tamponade were produced in ten open-chest dogs. During continuous monitoring of the electrocardiogram and the arterial and venous pressures, 10-30 cc of autologous, heparinized blood, or one of several other solutions, were intermittently infused into the pericardial sac until no effective blood pressure was recorded. The characteristic electrocardiographic findings of acute cardiac tamponade were peaked P waves, decrease of QRS complex voltage, left axis deviation of the QRS complex, deep T wave inversions, and ST-segment change. With the appearance of electromechanical dissociation, there was a sudden, vagally-mediated bradycardia. Because these changes are similar to those observed at the time of cardiac rupture, it was concluded that the electrocardiographic manifestations of cardiac rupture could be attributed to acute cardiac tamponade.

Key Words: Cardiac rupture • Bradycardia • Pericardial effusion • Electromechanical dissociation • Left axis deviation • Depressor reflexes • Vagus nerve • Electrical alternans

Submitted on January 29, 1974
Accepted on April 18, 1974

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