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Published in: Pediatric Cardiology 5/2007

01-10-2007

Sensitivity and Specificity of Echocardiographic Evidence of Tamponade: Implications for Ventricular Interdependence and Pulsus Paradoxus

Author: W.G. Guntheroth

Published in: Pediatric Cardiology | Issue 5/2007

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Abstract

The reported sensitivity of the echocardiographic finding of right atrial collapse for the diagnosis of tamponade ranges from 50% to100%; specificities have ranged from 33% to 100%. Its sensitivity in identifying right ventricular collapse ranges from 48% to 100% whereas the specificity ranges from 72% to 100%. Collapse of either the right atrium or right ventricle is not reliable except in cases where the risk of tamponade is high, consistent with Bayes’ theorem. If the patient has hypotension, tachycardia, dyspnea, increased venous pressure, and a pericardial effusion, the diagnosis of tamponade will likely be sustained. To explain pulsus paradoxus, most echocardiographic reports have invoked Dornhorst’s theory that inspiratory filling of the right ventricle actively collapses the left ventricle by successfully competing for a fixed total pericardial space (“ventricular interdependence”). However, the pericardial space is not fixed in tamponade but increases with inspiration, and the right heart is much more likely to collapse than the left, given their relative thickness. Pulsus paradoxus depends on the inspiratory surge to the right heart, exaggerated by the small stroke volume of both ventricles induced by tamponade, and vascular coupling between the pulmonary and systemic beds, with a transit time of one to two heart beats.
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Metadata
Title
Sensitivity and Specificity of Echocardiographic Evidence of Tamponade: Implications for Ventricular Interdependence and Pulsus Paradoxus
Author
W.G. Guntheroth
Publication date
01-10-2007
Publisher
Springer-Verlag
Published in
Pediatric Cardiology / Issue 5/2007
Print ISSN: 0172-0643
Electronic ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-005-0807-9

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