What features on echocardiography suggest the presence of tamponade physiology in the presence of a pericardial effusion?
These features include: -right ventricular diastolic collapse (specific) -right atrial systolic inversion (>1/3 systole, sensitive) -inferior vena cava plethora (>2.1 cm diameter) with little (<50%) respiratory variation -echo pulsus paradoxus (variation in mitral and tricuspid inflow "E" wave velocity >25% or 40%, respectively)
Cine loop 1: linear transducer placed in longitudinal orientation at the right mid-clavicular line, 3rd intercostal space. + lung sliding
Cine loop 2: linear transducer placed in longitudinal orientation at the left mid-clavicular line, 3rd intercostal space. + lung sliding
Cine loop 3: parasternal long axis view. Left ventricle hyperdynamic. Large circumferential pericardial effusion, completely anechoic. Subtle inward deflection of right ventricular free wall in mid-diastole, swinging heart.
Cine loop 4: apical 4 chamber view. Left ventricle hyperdynamic. large effusion re-demonstrated. right atrial systolic inversion.