Video clips showing examples of pericardial effusion obtained in the apical 4-chamber view
Notice:
– Apical views
– Pericardial fluid collection (white arrows)
– Compression of right atrium is obvious in image B and is a
classical echocardiographic sign of tamponade, but not a prerequisite for a clinical tamponade syndrome
Video clips showing examples of pericardial effusion obtained in the subcostal 4-chamber view
Notice:
– S4CH views
– Pericardial fluid collection (white arrows)
Compression of the right sided cavities in diastole is not obvious in these clips
Dilated, poorly functioning RV 2D echocardiography
The characteristics:
– RV dimension is increased
– Paradoxical interventricular movement
– LV is compressed by RV
–
Video clips of the parasternal long axis view
Notice
– Enlarged RV (arrows)
– RV size >2/3 of LV size except in D where there is a concomitant dilated and dysfunctioning LV
Right ventricle enlargement and myocardial dysfunction is seen in right side myocardial infarction and pressure increase (pulmonary embolus and chronic pulmonary hypertension)
Often a tricuspidal regurgitation is seen on colour Doppler and continuous wave Doppler will disclose a RV pressure increase (Advanced FATE level)
Video clips of the parasternal short axis view
Notice:
– Enlarged RV
– D-shaped left ventricle
– Paradoxial movement of the interventricular septum
– Arrows pointing to dilated right ventricle
Right ventricle enlargement and myocardial dysfunction is seen in right side myocardial infarction and pressure increase (pulmonary embolus and chronic pulmonary hypertension)
In acute enlargement the high pressure in the right ventricle will compress the left ventricle resulting in typical paradoxial interventricular septal movement and D-shape of the left ventricle
Video clips showing examples of pericardial effusion obtained in the parasternal short axis view
Notice:
– PSAX views
– Pericardial fluid collection (white arrows)
Compression of the right-sided cavities in diastole is not obvious in these clips
Video clips showing examples of pericardial effusion obtained in the parasternal long axis view
Notice:
– PLAX views
– Pericardial fluid collection (arrows)
Compression of the right-sided cavities in diastole is not obvious in these
Cardiac tamponade is a clinical condition where the pericardial effusion compromises the cardiac function; it may become fatal
Every physician should be able to recognise the clinical characteristics and signs of cardiac tamponade:
– Cardiac tamponade is a CLINICAL diagnosis
– Cardiac tamponade is NOT an echocardiographic diagnosis
– Pericardial effusion can often be seen with ultrasound, but the sonographic size is not
important
– The clinical presentation is of paramount importance
If therapeutic evacuation of the pericardial effusion (pericardiocentesis) stabilises the haemodynamics of the patient, the diagnosis
In cases with pericardial effusion different echocardiographic and clinical characteristics are observed
2D echocardiographic characteristics:
– Pericardial fluid collection
– Compression of the right-sided cavities in diastole (often not present)
Clinical characteristics:
– 5 mm wide pericardial fluid collection is within normal range
– Badly tolerated in LV hypertrophy
– Badly tolerated in postoperative cardiac surgery
– Badly tolerated in rapidly developing PE
Short axis view showing hypertrophic LV with preserved LV function
Notice:
– Myocardial wall thickness is increased
– LV dimensions are decreased
