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Case Reports
. 2012 Apr 23:2012:bcr0920114792.
doi: 10.1136/bcr.09.2011.4792.

Unraveling the paradox of cardiac tamponade: case presentation and discussion of physiology

Robert Michael Reed  1 , Gautam V Ramani, Salman Hashmi
Affiliations
Case Reports

Unraveling the paradox of cardiac tamponade: case presentation and discussion of physiology

Robert Michael Reed et al. BMJ Case Rep. .

Abstract

A 53-year-old man on warfarin for postoperative pulmonary embolism presented with chest pain and was found to be in cardiac tamponade due to an atraumatic haemopericardium. Findings of tamponade and a novel approach to the pathophysiology of pericardial disease to explain these finding are presented.

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Conflict of interest statement

Competing interests None.

Figures

Figure 1
Figure 1
(A) Chest radiograph immediately prior to surgery. (B) Chest radiograph 2 weeks postop showing enlarged cardiac silhouette with clear lung fields. (C) Baseline ECG. (D) ECG 2 weeks postop demonstrating low voltage.
Figure 2
Figure 2
CT scan demonstrating a large pericardial effusion.
Figure 3
Figure 3
Electrical alternans. Beat-to-beat oscillation of QRS complex is attributable to motion of the heart within a large pericardial effusion.
Figure 4
Figure 4
Trans-thoracic echocardiogram with doppler view of flow across the mitral valve. Note the large pericardial effusion and the variation in flow with respiration representing the ‘doppler flow-velocity paradoxus.’
Video 1
Video 1
Apical four-chamber view and rhythm strip demonstrating electrical alternans.
Video 2
Video 2
Parasternal short-axis view and rhythm strip demonstrating electrical alternans.
Figure 5
Figure 5
Conceptualised pressure-volume curves of tamponade and constrictive pericarditis. Note that the Y axis represents volume in tamponade versus pressure in constrictive pericarditis. The X axis in both represents the period of diastolic filling.
See this image and copyright information in PMC

References

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