This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hoit, B. D. Articles by Fowler, N. O. Search for Related Content PubMed PubMed Citation Articles by Hoit, B. D. Articles by Fowler, N. O.

Circulation, Vol 82, 1370-1376, Copyright © 1990 by American Heart Association

ARTICLES

Cardiac tamponade in left ventricular dysfunction

BD Hoit, M Gabel and NO Fowler
University of Cincinnati Medical Center, Division of Cardiology, Ohio 45267.

Echocardiographic and hemodynamic data were measured in closed-chest dogs during graded cardiac tamponade (pericardial pressure 5, 10, and 15 mm Hg) before and after production of diffuse ischemic left ventricular dysfunction. Left ventricular dysfunction was produced by intracoronary injection of nonradioactive microspheres (54 +/- 3.9 mm diameter). Changes in left atrial pressure with cardiac tamponade were influenced by coexisting left ventricular dysfunction. Left atrial pressure increased with tamponade and was equal to pericardial pressure before left ventricular dysfunction was produced. However, after left ventricular dysfunction was produced, left atrial pressure was significantly higher than pericardial pressure before tamponade, but it fell toward pericardial pressure when tamponade was produced. Pulsus paradoxus (greater than 10 mm Hg) was present in all animals with cardiac tamponade before left ventricular dysfunction but in only one animal afterward. During each level of tamponade, the inspiratory fall of aortic systolic pressure was greater before than with left ventricular dysfunction. The slope of the linear regression between pericardial pressure and millimeters of mercury of inspiratory fall in aortic systolic pressure was significantly greater before than with left ventricular dysfunction (0.74 +/- 0.12 versus 0.32 +/- 0.12, p less than 0.05). Left ventricular dysfunction caused a leftward and upward shift of the pericardial pressure-volume relation. As a result, right atrial and ventricular collapse occurred with significantly smaller volumes of pericardial fluid after than before left ventricular dysfunction. We conclude that pulsus paradoxus may be absent in cardiac tamponade with coexisting left ventricular dysfunction and unequal filling pressures. Echocardiographic signs of cardiac tamponade may occur with small effusions in the presence of left ventricular dysfunction.

This article has been cited by other articles:

				W. C. Little and G. L. Freeman Pericardial Disease Circulation, March 28, 2006; 113(12): 1622 - 1632. [Full Text] [PDF]

				C. R Gibbs, R. D S Watson, S. P Singh, and G. Y H Lip Management of pericardial effusion by drainage: a survey of 10 years' experience in a city centre general hospital serving a multiracial population Postgrad. Med. J., December 1, 2000; 76(902): 809 - 813. [Abstract] [Full Text]