Ultrasonography of Cardiac Tamponade

• Drs. Conrad, Madden, and Cutright
• Team Sono: Drs. Hanuscin and Lee
• Edited by: Dr. Murphy

Case background:

A middle-aged woman presented to the ED with a few weeks of progressively worsening dyspnea on exertion. POCUS showed moderate-sized pericardial effusion with signs of RV diastolic collapse and RA systolic collapse.

POCUS Pearl: How can we use ultrasonography to evaluate for signs of RV collapse?

1. Use M-mode to evaluate EPSS: discordance of mitral valve opening and RV free wall in diastole. 

2. Use Doppler over Mitral Valve to evaluate for mitral valve inflow variation (valvular pulsus paradoxus)

3. Evaluate for a plethoric IVC.

Check out more examples here:

• POCUS Atlas – M mode RV diastolic collapse
• POCUS Atlas – Plethoric IVC in Tamponade
• WikEM – MV inflow respiratory variation (valvular pulsus paradoxus)

Case Conclusion: Using dynamic ultrasonography, the ED team performed pericardiocentesis and placed a pericardial drain with significant improvement in hemodynamic status.

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Marie J Murphy, MD MPH

PGY-3 in Emergency Medicine at SUNY Downstate Medical Center/Kings County Hospital Center. Webmaster for Clinical Monster and County EM Blog. Co-leader for Health Policy and Informatics Mini Fellowship with an interest in Clinical Health Informatics.

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