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Critical Care Echocardiography: Pericardial Disease, Tamponade, and Other Topics

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Ultrasound in the Intensive Care Unit

Part of the book series: Respiratory Medicine ((RM))

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Abstract

Pericardial effusion with tamponade physiology is an underrecognized and life-threatening but treatable cause of hemodynamic impairment in the critical care setting. As fluid accumulates in the pericardial space, the pericardial pressure exceeds the intracardiac pressure and diminishes cardiac output. Goal-directed critical care echocardiography performed at the bedside can promptly detect a pericardial effusion, which is visualized as an echo-free space surrounding the heart. In the proper clinical context, echocardiographic signs of tamponade, such as diastolic collapse of the right-sided chambers and plethora of the inferior vena cava, can help to establish the diagnosis of cardiac tamponade. This chapter will review technical considerations, imaging acquisition and interpretation, and pitfalls in the critical care ultrasound assessment of pericardial effusion and tamponade.

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References

  1. Wheeler AP, Bernard GR, Thompson BT, Schoenfeld D, Wiedemann HP, deBoisblanc B, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006;354(21):2213–24.

    Article  PubMed  Google Scholar 

  2. Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364(8):749–57.

    Article  CAS  PubMed  Google Scholar 

  3. Beaulieu Y. Bedside echocardiography in the assessment of the critically ill. Crit Care Med. 2007;35(5 Suppl):S235–49.

    Article  PubMed  Google Scholar 

  4. Nagdev A, Stone MB. Point-of-care ultrasound evaluation of pericardial effusions: does this patient have cardiac tamponade? Resuscitation. 2011;82(6):671–3.

    Article  PubMed  Google Scholar 

  5. Mandavia DP, Hoffner RJ, Mahaney K, Henderson SO. Bedside echocardiography by emergency physicians. Ann Emerg Med. 2001;38(4):377–82.

    Article  CAS  PubMed  Google Scholar 

  6. Melamed R, Sprenkle MD, Ulstad VK, Herzog CA, Leatherman JW. Assessment of left ventricular function by intensivists using hand-held echocardiography. Chest. 2009;135(6):1416–20.

    Article  PubMed  Google Scholar 

  7. Vignon P, Dugard A, Abraham J, Belcour D, Gondran G, Pepino F, et al. Focused training for goal-oriented hand-held echocardiography performed by noncardiologist residents in the intensive care unit. Intensive Care Med. 2007;33(10):1795–9.

    Article  PubMed  Google Scholar 

  8. Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr. 2010;23(12):1225–30.

    Article  PubMed  Google Scholar 

  9. Kaplan A, Mayo PH. Echocardiography performed by the pulmonary/critical care medicine physician. Chest. 2009;135(2):529–35.

    Article  PubMed  Google Scholar 

  10. Catherine M, Otto M. Pericardial Disease. In: Catherine M, Otto M, editors. Text book of clinical echocardiography. 4th ed. Philadelphia: Saunders Elsevier; 2009. p. 242–58.

    Google Scholar 

  11. Schairer JR, Biswas S, Keteyian SJ, Ananthasubramaniam K. A systematic approach to evaluation of pericardial effusion and cardiac tamponade. Cardiol Rev. 2011;19(5):233–8.

    Article  PubMed  Google Scholar 

  12. Bodson L, Bouferrache K, Vieillard-Baron A. Cardiac tamponade. Curr Opin Crit Care. 2011;17(5):416–24.

    Article  PubMed  Google Scholar 

  13. Roy CL, Minor MA, Brookhart MA, Choudhry NK. Does this patient with a pericardial effusion have cardiac tamponade? JAMA. 2007;297(16):1810–8.

    Article  CAS  PubMed  Google Scholar 

  14. Spodick DH. Acute cardiac tamponade. N Engl J Med. 2003;349(7):684–90.

    Article  PubMed  Google Scholar 

  15. Curtiss EI, Reddy PS, Uretsky BF, Cecchetti AA. Pulsus paradoxus: definition and relation to the severity of cardiac tamponade. Am Heart J. 1988;115(2):391–8.

    Article  CAS  PubMed  Google Scholar 

  16. Himelman RB, Kircher B, Rockey DC, Schiller NB. Inferior vena cava plethora with blunted respiratory response: a sensitive echocardiographic sign of cardiac tamponade. J Am Coll Cardiol. 1988;12(6):1470–7.

    Article  CAS  PubMed  Google Scholar 

  17. Maisch B, Seferovic PM, Ristic AD, Erbel R, Rienmuller R, Adler Y, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J. 2004;25(7):587–610.

    Article  PubMed  Google Scholar 

  18. William F, Armstrong TR. Feigenbaum’s echocardiography. Philadelphia: Lippincott Williams & Wilkins; 2009.

    Google Scholar 

  19. Gillam LD, Guyer DE, Gibson TC, King ME, Marshall JE, Weyman AE. Hydrodynamic compression of the right atrium: a new echocardiographic sign of cardiac tamponade. Circulation. 1983;68(2):294–301.

    Article  CAS  PubMed  Google Scholar 

  20. Merce J, Sagrista-Sauleda J, Permanyer-Miralda G, Evangelista A, Soler-Soler J. Correlation between clinical and Doppler echocardiographic findings in patients with moderate and large pericardial effusion: implications for the diagnosis of cardiac tamponade. Am Heart J. 1999;138(4 Pt 1):759–64.

    Article  CAS  PubMed  Google Scholar 

  21. Kerber RE, Gascho JA, Litchfield R, Wolfson P, Ott D, Pandian NG. Hemodynamic effects of volume expansion and nitroprusside compared with pericardiocentesis in patients with acute cardiac tamponade. N Engl J Med. 1982;307(15):929–31.

    Article  CAS  PubMed  Google Scholar 

  22. Kircher B, Himmelman R. Non invasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. 1990;66:493–6.

    Article  CAS  PubMed  Google Scholar 

  23. Tsang TS, Enriquez-Sarano M, Freeman WK, Barnes ME, Sinak LJ, Gersh BJ, et al. Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc. 2002;77(5):429–36.

    Article  PubMed  Google Scholar 

  24. Schmidt GA, Koenig S, Mayo PH. Shock: ultrasound to guide diagnosis and therapy. Chest. 2012;142(4):1042–8.

    Article  PubMed  Google Scholar 

  25. Spevack DM, Tunick PA, Kronzon I. Hand carried echocardiography in the critical care setting. Echocardiography. 2003;20(5):455–61.

    Article  PubMed  Google Scholar 

  26. Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ, Patel AR, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians. J Am Soc Echocardiogr. 2011;24(3):229–67.

    Article  PubMed  Google Scholar 

  27. Price S, Via G, Sloth E, Guarracino F, Breitkreutz R, Catena E, et al. Echocardiography practice, training and accreditation in the intensive care: document for the World Interactive Network Focused on Critical Ultrasound (WINFOCUS). Cardiovasc Ultrasound. 2008;6:49.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Cholley B. International expert statement on training standards for critical care ultrasonography. Intensive Care Med. 2011;37(7):1077–83.

    Article  Google Scholar 

  29. Mayo PH, Beaulieu Y, Doelken P, Feller-Kopman D, Harrod C, Kaplan A, et al. American College of Chest Physicians/La Societe de Reanimation de Langue Francaise statement on competence in critical care ultrasonography. Chest. 2009;135(4):1050–60.

    Article  PubMed  Google Scholar 

  30. Bossone E, DiGiovine B, Watts S, Marcovitz PA, Carey L, Watts C, et al. Range and prevalence of cardiac abnormalities in patients hospitalized in a medical ICU. Chest. 2002;122(4):1370–6.

    Article  PubMed  Google Scholar 

  31. Joseph MX, Disney PJ, Da Costa R, Hutchison SJ. Transthoracic echocardiography to identify or exclude cardiac cause of shock. Chest. 2004;126(5):1592–7.

    Article  PubMed  Google Scholar 

  32. Vignon P, Chastagner C, Francois B, Martaille JF, Normand S, Bonnivard M, et al. Diagnostic ability of hand-held echocardiography in ventilated critically ill patients. Crit Care. 2003;7(5):R84–91.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Biais M, Carrie C, Delaunay F, Morel N, Revel P, Janvier G. Evaluation of a new pocket echoscopic device for focused cardiac ultrasonography in an emergency setting. Crit Care. 2012;16(3):R82.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Saito Y, Donohue A, Attai S, Vahdat A, Brar R, Handapangoda I, et al. The syndrome of cardiac tamponade with “small” pericardial effusion. Echocardiography. 2008;25(3):321–7.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Winthrop University Hospital, 222 Station Plaza, Suite 400, Mineola, NY, 11501, USA

    Girish B. Nair M.D., FCCP

  2. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Winthrop-University Hospital, 222 Station Plaza North, Suite 400, Mineola, NY, 11501, USA

    Joseph P. Mathew M.D., FCCP

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  1. Girish B. Nair M.D., FCCP
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  2. Joseph P. Mathew M.D., FCCP
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Correspondence to Girish B. Nair M.D., FCCP .

Editor information

Editors and Affiliations

  1. Providence VA Medical Center, Warren Alpert Medical School Brown University, Providence, Rhode Island, USA

    Matthew Jankowich

  2. Memorial Hospital of Rhode Island, Warren Alpert Medical School Brown University, Pawtucket, Rhode Island, USA

    Eric Gartman

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Nair, G.B., Mathew, J.P. (2015). Critical Care Echocardiography: Pericardial Disease, Tamponade, and Other Topics. In: Jankowich, M., Gartman, E. (eds) Ultrasound in the Intensive Care Unit. Respiratory Medicine. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-1723-5_7

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  • DOI: https://doi.org/10.1007/978-1-4939-1723-5_7

  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-4939-1722-8

  • Online ISBN: 978-1-4939-1723-5

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