Cardiac Tamponade

Cardiac tamponade. A cross-section of the heart shows rupture of a myocardial infarct (arrow) with the accumulation of a large quantity of blood in the pericardial cavity.

<bold>Box 2.1 CARDIAC TAMPONADE</bold>

Cardiac tamponade. Midsagittal view showing fluid-filled pericardial sac and subxiphoid surgical approach.

<bold>Figure 32.3 </bold> Simultaneous right atrial (RA) and intrapericardial pressure (scale 0 to 40 mm Hg) and femoral artery (FA) pressure (scale 0 to 100 mm Hg) recorded in a patient with cardiac tamponade. <bold>A.</bold> Recordings before pericardiocentesis show the presence of systemic hypotension and the elevation and equalization of the RA and intrapericardial pressures. Note that a systolic x descent is present, but the diastolic y descent is absent, suggesting that RA emptying in early dias...

<bold><italic>FIGURE 9.44.</bold></bold> Apical four-chamber view recorded in a patient with a large pericardial effusion (<italic>PEF</bold>) and cardiac tamponade. Ultrasound guidance is being used as a needle is placed into the pericardial space. The needle is seen as a bright echo density (<italic>arrows</bold>) lateral to the right ventricular free wall. LV, left ventricle; RV, right ventricle.

<bold>FIGURE 11-21. Rupture of an acute myocardial infarct.</bold> An elderly woman with a recent myocardial infarct died of cardiac tamponade. The pericardium was filled with blood, and the cut surface of the left ventricle shows a linear rupture of the necrotic myocardium.

Aspirating pericardial fluid In pericardiocentesis, a needle and syringe are inserted through the chest wall into the pericardial sac (as shown below). Electrocardiographic (ECG) monitoring, with a leadwire attached to the needle and electrodes placed on the limbs (right arm [RA], left arm [LA], and left leg [LL]), helps ensure proper needle placement and avoids damage to the heart.

FIGURE 26.7. Chest roentgenogram demonstrates a large pericardial effusion, blunting of the left costophrenic angle, and patchy pulmonary infiltrates in a patient with systemic lupus erythematosus.

Figure 128.9. Pericardial effusion: This is a subcostal view of the heart, revealing a large circumferential pericardial effusion. The pericardial fluid is represented by the black, anechoic area (arrows) between the brightly echogenic pericardium and the myocardial wall.