Diagnosis of cardiac tamponade after cardiac surgery: relative value of clinical, echocardiographic, and hemodynamic signs.
Early detection and treatment of cardiac tamponade is crucial in management of patients after cardiac surgery. Because of the atypical features of this condition and paucity of data on relative frequency of different signs, we evaluated the sensitivity of various clinical, echocardiographic, and hemodynamic signs. We retrospectively evaluated the relative frequency of clinical, echocardiographic, and hemodynamic signs in 29 patients with cardiac tamponade after cardiac surgery. In our study 66% had a localized, posterior pericardial effusion, and the other 34% had circumferential pericardial effusion. In the whole group 24% of patients had hypotension, and pulsus paradoxus was noted in 48%, right atrial collapse in 34%, right ventricular diastolic collapse in 27%, left ventricular diastolic collapse in 65%, and left atrial collapse in 13%. Elevation with equalization of pressures was noted in 81% patients. In the patient group with circumferential pericardial effusion and cardiac tamponade 40% patients were hypotensive and 50% patients had pulsus paradoxus. RA collapse was present in 70%, RV diastolic collapse in 70%, and LV diastolic collapse in 20%. Elevated diastolic pressures with equalization of these pressures was present in 71%. In the group with regional pericardial effusion and cardiac tamponade hypotension was present in 16% and pulsus paradoxus in 47%. RA collapse was present in 16%, RV diastolic collapse in 5%, LV diastolic collapse in 89%, and LA collapse in 21% of the patients with regional tamponade. Elevated diastolic pressures with equalization of these pressures was noted in 86% of the patients. Our observations indicate that among patients who have undergone cardiac surgery the presentation of cardiac tamponade is usually atypical.(ABSTRACT TRUNCATED AT 250 WORDS)
Chuttani
K
K
Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, Mass 02111.
Tischler
M D
MD
Pandian
N G
NG
Lee
R T
RT
Mohanty
P K
PK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D002305:Cardiac Tamponade / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography