Cardiac Catheterization Evaluation of a Patient with Pericardial Disease

Abstract

Differentiating between pericardial constriction and restrictive myocardial disease can be extremely difficult, and the cardiac catheterization laboratory provides a number of powerful ways in which pericardial disease can be evaluated, or in which a suspected diagnosis can be confirmed. In fact, all cath lab operators should be well versed in the interpretation of invasive hemodynamic data. While a comprehensive constriction study involves several measurements that are made using simultaneous (duel-transducer) left and right heart catheters, it is equally important to be alert to the signs and symptoms of acute pericardial disease, which may be noticed during other, routine cath lab procedures. Cardiac tamponade can rarely but rapidly develop during different procedures in the catheterization laboratory like coronary artery perforation during a percutaneous intervention (PCI), right ventricular injury during a myocardial biopsy or pacing wire insertion, or an injury during transseptal catheterization or electrophysiology procedures like ablation or lead extraction. Failure to quickly make a diagnosis may potentially delay otherwise life saving interventions. Thus, this section will focus on the normal hemodynamic relationships of the heart and pericardium, the steps required to perform a dedicated study to differentiate pericardial constriction from restrictive myocardial disease, and the hemodynamic findings of acute cardiac tamponade.