Normal Pericardial Physiology and Tamponade Physiology - NT 正常心包填塞生理学和生理学NT.pptVIP

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Normal Pericardial Physiology and Tamponade Physiology - NT 正常心包填塞生理学和生理学NT.ppt

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Normal Pericardial Physiology and Tamponade Physiology - NT 正常心包填塞生理学和生理学NT

Tamponade Physiology The compressive effects of the pericardial pressure is most prominent during the phase of the cardiac cycle when the pressure of the chamber in question is the lowest. Ventricles ? Early Diastole Atria ? Systole ? RA Compression Weyman (Pg.1122) RA Inversion Begins in late diastole Continues into ventricular systole for variable period before normalizing RA Compression Feigenbaum pg.561 “The most common finding [of tamponade] is diastolic invagination of the Rt. Ventricular and/or Rt. Atrial wall during diastole.” RA Compression RA inversion Extremely sensitive sign of clinical tamponade Specificity only 50% Correlation with likelihood of tamponade: Extent of inversion NO Duration of inversion YES RA inversion lasting 1/3 of the cycle has a specificity of 100% and Sensitivity of 94% for clinical tampnade 2-D Features of Tamponade The longer the duration of RA inversion the higher the probability of tampodane Inversion 1/3 of systole 94% Sensitive 100% Specific RA free wall is a thin flexible structure ? brief inversion can occur without Tamponade. RV Compression No controversy as to the exact timing of RV free wall inversion Early diastole May be transient OR May persist throughout diastole. RV diastolic collapse Occurs when: Intrapericardial pressure RV pressure RV Diastolic Collapse (RVDC) Also affected by: Intravascular volume Low pressure tamponade RV Pressure RVH and PHTN = RVDC at higher pressures Chamber compliance RV: Ischemia, Trauma, Post CABG adhesions LV : Ditto LV less compliant = shape alteration is minimal compared to Atria or RV despite pressure equalization RV Inversion RV inversion preceeds the onset of clinical tamponade Significant Drop in MAP Onset of Pulsus Continued increase in intrapericardial pressure ? Increasing prominence of RV inversion In severe tamponade RV inversion persists throughout diastole Rate of PE Accumulation also affects Tamponade Physiology Volume of the fluid Rate of accum