- Email: [email protected]
Collapse of three cardiac chambers due to a pericardial effusion
International Journal of Cardiology 123 (2008) e62 – e63 www.elsevier.com/locate/ijcard
Letter to the Editor
Collapse of three cardiac chambers due to a pericardial effusion Wilfried Mullens ⁎, Jan De Keyser, Marie-Christine Herregods Department of Cardiology, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium Received 28 September 2006; accepted 18 November 2006 Available online 22 February 2007
Abstract We report a case of pericardial effusion with collapse of three cardiac chambers including the left atrium, a very specific sign of tamponade always urging for quick pericardiocentesis. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Tamponade; Collapse left atrium; Pericardiocentesis
1. Case report A 62 y/o male with a carcinoma of the lung was admitted to the emergency ward with sudden onset of dyspnea. Clinical examination revealed a respiratory rate of 25/min, a markedly elevated jugular venous pressure, cold extremities, a blood pressure of 80/40 mm Hg which clearly dropped after inspiration and a normal lung auscultation. The electrocardiogram showed a sinustachycardia of 140 bpm with low voltage QRS-complexes. Transthoracic echocardiogram documented a moderate pericardial effusion and collapse of both atria and the right ventricle (Figs. 1 and 2). The symptoms immediately resolved after catheter pericardiocentesis. The right atrium and ventricle are compliant structures so increased intrapericardial pressure lead to their collapse when intracavitary pressures, mainly in diastole, are only slightly exceeded by those in the pericardium. Right atrial collapse, especially when it persists for more than one-third
⁎ Corresponding author. Tel.: +32 16 344249; fax: +32 16 344240. E-mail address: [email protected] (W. Mullens). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2006.11.155
of the cardiac cycle, is a sensitive sign and collapse of the right ventricle is a more specific sign of tamponade [1,2]. In contrast, left atrial collapse is only seen in about 25% of patients but is the most specific sign for tamponade always urging for a quick drainage [3]. Left ventricular collapse is very rare since the wall of the left ventricle is more muscular. References [1] Leimgruger PP, Klopfenstein HS, Wann LS, Brooks HL. The hemodynamic derangement associated with right ventricular diastolic collapse in cardiac tamponade: an experimental echocardiographic study. Circulation 1983;68:612–20. [2] Singh S, Wann LS, Schuchard GH, et al. Right ventricular and right atrial collapse in patients with cardiac tamponade. A combined echocardiographic and hemodynamic study. Circulation 1984;70:966–71. [3] Reydel B, Spodick DH. Frequency and significance of chamber collapses during cardiac tamponade. Am Heart J 1990;119:1160–3.
W. Mullens et al. / International Journal of Cardiology 123 (2008) e62–e63
Fig. 1. Parasternal short axis view. Collapse of the right ventricle (1) and right atrium (2).
Fig. 2. Parasternal long axis view. Collapse of the right ventricle (1) and left atrium (2).
e63
Letter to the Editor
Collapse of three cardiac chambers due to a pericardial effusion Wilfried Mullens ⁎, Jan De Keyser, Marie-Christine Herregods Department of Cardiology, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium Received 28 September 2006; accepted 18 November 2006 Available online 22 February 2007
Abstract We report a case of pericardial effusion with collapse of three cardiac chambers including the left atrium, a very specific sign of tamponade always urging for quick pericardiocentesis. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Tamponade; Collapse left atrium; Pericardiocentesis
1. Case report A 62 y/o male with a carcinoma of the lung was admitted to the emergency ward with sudden onset of dyspnea. Clinical examination revealed a respiratory rate of 25/min, a markedly elevated jugular venous pressure, cold extremities, a blood pressure of 80/40 mm Hg which clearly dropped after inspiration and a normal lung auscultation. The electrocardiogram showed a sinustachycardia of 140 bpm with low voltage QRS-complexes. Transthoracic echocardiogram documented a moderate pericardial effusion and collapse of both atria and the right ventricle (Figs. 1 and 2). The symptoms immediately resolved after catheter pericardiocentesis. The right atrium and ventricle are compliant structures so increased intrapericardial pressure lead to their collapse when intracavitary pressures, mainly in diastole, are only slightly exceeded by those in the pericardium. Right atrial collapse, especially when it persists for more than one-third
⁎ Corresponding author. Tel.: +32 16 344249; fax: +32 16 344240. E-mail address: [email protected] (W. Mullens). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2006.11.155
of the cardiac cycle, is a sensitive sign and collapse of the right ventricle is a more specific sign of tamponade [1,2]. In contrast, left atrial collapse is only seen in about 25% of patients but is the most specific sign for tamponade always urging for a quick drainage [3]. Left ventricular collapse is very rare since the wall of the left ventricle is more muscular. References [1] Leimgruger PP, Klopfenstein HS, Wann LS, Brooks HL. The hemodynamic derangement associated with right ventricular diastolic collapse in cardiac tamponade: an experimental echocardiographic study. Circulation 1983;68:612–20. [2] Singh S, Wann LS, Schuchard GH, et al. Right ventricular and right atrial collapse in patients with cardiac tamponade. A combined echocardiographic and hemodynamic study. Circulation 1984;70:966–71. [3] Reydel B, Spodick DH. Frequency and significance of chamber collapses during cardiac tamponade. Am Heart J 1990;119:1160–3.
W. Mullens et al. / International Journal of Cardiology 123 (2008) e62–e63
Fig. 1. Parasternal short axis view. Collapse of the right ventricle (1) and right atrium (2).
Fig. 2. Parasternal long axis view. Collapse of the right ventricle (1) and left atrium (2).
e63