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Journal ArticleDOI

Echocardiographic diagnosis of pericardial effusion.

01 Nov 1970-American Journal of Cardiology (Elsevier)-Vol. 26, Iss: 5, pp 475-479
TL;DR: In many institutions echocardiography is becoming the examination of choice for the detection or exclusion of pericardial effusion, because of its ability to detect intracardiac structures in a noninvasive manner.
Abstract: Echocardiography, because of its ability to detect intracardiac structures in a noninvasive manner, has been increasing in importance as a cardiologic diagnostic tool. The ultrasonic diagnosis of pericardial effusion has stimulated much of the interest in echocardiography in this country. With this technique pericardial fluid is recorded as a relatively echo-free space between the posterior left ventricular epicardium and the posterior pericardium. Anterior fluid is seen as a similar echo-free space between the anterior right ventricular wall and the anterior chest wall. Although the examination is fairly simple and frequently can be performed in a few minutes, the examiner must be aware of technical details, especially with respect to direction of the transducer and control settings on the echograph. In addition, it may be difficult to obtain satisfactory echocardiographic recordings in some patients, such as those with marked pulmonary emphysema. However, these few limitations are overshadowed by the many advantages of a harmless, sensitive, bedside examination for pericardial fluid. Thus, in many institutions echocardiography is becoming the examination of choice for the detection or exclusion of pericardial effusion.
Citations
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Journal ArticleDOI
TL;DR: It is clearly important that the medical profession plays a significant role in critically evaluation of the use of diagnostic procedures and therapies in the management or prevention of disease.
Abstract: ### Preamble It is clearly important that the medical profession plays a significant role in critically evaluation of the use of diagnostic procedures and therapies in the management or prevention of disease. Rigorous and expert analysis of the available data documenting relative benefits and risks of those procedures and therapies can produce helpful guidelines that …

718 citations

Journal ArticleDOI
TL;DR: A method of estimating pericardial volume is proposed, which uses the difference between the cubed diameters at the end-diastole of thepericardium and epicardium, which is based on echocardiograms of diagnostic quality.
Abstract: In order to evaluate the reliability and sensitivity of echocardiograms for detecting and quantitating pericardial effusion, 41 patients had echocardiograms on the day prior to cardiac operation. A fluid trap was used to aspirate the pericardium at operation. Thirty-nine of 41 patients had echocardiograms of diagnostic quality. In 25 patients, the echocardiogram was negative for pericardial effusion, with 0-16 ml identified at operation. In 13 patients, the echocardiogram was positive for pericardial effusion, with 15-775 ml aspirated at operation. A transition of patterns of relative posterior epicardial-pericardial movement was noted as the pericardial fluid volume increased. More than 15 ml was always found when a posterior echo-free space persisted throughout the cardiac cycle between a flat pericardium relative to the epicardium. In the presence of such a posterior echo-free space, a large anterior echo-free space made a moderately large pericardial effusion likely. In the absence of this diagnostic posterior echo-free space, an anterior echo-free space had no diagnostic significance, as it was found in 11 patients with less than 16 ml of pericardial effusion. A small posterior echo-free space persisting throughout the cardiac cycle between pericardial and epicardial echoes demonstrating virtually identical movements was found in two patients without any surgical evidence for pericardial effusion, but with evidence of adhesive fibrocalcific pericardial disease. A method of estimating pericardial volume is proposed, which uses the difference between the cubed diameters at the end-diastole of the pericardium and epicardium.

405 citations

Journal ArticleDOI
TL;DR: Two-dimensional echocardiography provided better separation of normals from right ventricular volume overload patients than did M-mode techniques, and enables accurate visualization of the right atrium and ventricle in almost all patients.
Abstract: No data are available on determining right atrial and right ventricular size by two-dimensional echocardiography. We performed two-dimensional echocardiograms on eight human right-heart casts obtained at autopsy and on 50 patients who underwent complete left- and right-heart catheterization. Measurement of individual dimensions of the long and short axes of the right atrium and ventricle from right heart casts closely correlated with the volume of these structures as determined by water displacement. Further, individual dimensions by cross-sectional echo correlated well with actual casts dimensions. Subsequently, echocardiographic measurements of right atrial and ventricular long and short axes were obtained in the apical four-chambered view in a group of normals and compared with a group of patients with right ventricular volume overload states. Mean values for right atrial short-axis and long-axis measurements were greater in right ventricular volume overload patients than in normals: 6.5 +/- 0.3 vs 3.6 +/- 0.1 cm, and 6.0 +/- 0.3 vs 4.2 +/- 0.1 cm, respectively (both p less than 0.001). In addition, measurements of both individual dimensions as well as planed area of the right ventricle were greater in right ventricular volume overload patients than in normals: maximal short axis 6.1 +/- 0.3 vs 3.5 +/- 0.2 cm, mid-short axis 6.1 %/- 0.4 vs 2.8 +/- 0.2 cm, and area 40 +/- 2.6 vs 18 +/- 1.2 cm2 (all p less than 0.001). There were no differences in right ventricular long-axis measurement. Two-dimensional echocardiography provided better separation of normals from right ventricular volume overload patients than did M-mode techniques. Thus, two-dimensional echocardiography, with the apical four-chambered view, enables accurate visualization of the right atrium and ventricle in almost all patients. Futher, measurements of right atrial and right ventricular size by two-dimensional echocardiography readily distinguish normal patients from those with right ventricular volume overload.

284 citations

Journal ArticleDOI
TL;DR: The cases of 56 medical patients with cardiac tamponade who were treated at the University of Cincinnati were reviewed, finding that a paradoxic arterial pulse was critical in the diagnosis because most patients did not have a small quiet heart, and blood pressure was often well maintained.
Abstract: We reviewed the cases of 56 medical patients wih cardiac tamponade who were treated at the University of Cincinnati. A paradoxic arterial pulse was critical in the diagnosis because most patients did not have a small quiet heart, and blood pressure was often well maintained. Fifty-two of 55 patients had enlarged cardiac silhouette by chest radiogram; heart sounds were diminished in 19 patients; arterial systolic pressure was greater than or equal to 100 mm Hg in 35, and arterial pulse pressure was greater than or equal to 40 mm Hg in 27. Echocardiograms in 23 patients showed abnormally increased right ventricular dimensions and decreased left ventricular dimensions during inspiration, except in one patient with left ventricular dysfunction. The causes of cardiac tamponade were metastatic tumor in 18 patients, idiopathic pericarditis in eight and uremia in five; five cases of tamponade occurred after heparin administration in acute cardiac infarction. Myxedema and dissecting aneurysm each caused tamponade in two patients. Pericardiocentesis relieved tamponade initially in 40 of 46 patients; however, two suffered fatal complications. Pericardial resection was done in 18, including 12 of these 46.

272 citations

Journal ArticleDOI
TL;DR: It is concluded that right atrial inversion, particularly if prolonged, is a useful echocardiographic marker of cardiac tamponade that may be of particular diagnostic value when the clinical picture is unclear.
Abstract: The relationship of right atrial inversion, a previously undescribed cross-sectional echocardiographic sign, to the presence of cardiac tamponade was examined. We studied 127 patients with moderate or large pericardial effusions. Cardiac tamponade was present in 19 and absent in 104. Four patients with equivocal tamponade were excluded from analysis. Right atrial inversion was present in 19 of 19 patients with cardiac tamponade and 19 of 104 without cardiac tamponade (sensitivity, 100%; specificity, 82%; predictive value, 50%). The degree of inversion as quantitated by the area-corrected curvature did not improve the ability to discriminate between patients with and without cardiac tamponade. However, consideration of the duration of inversion by the right atrial inversion time index (duration of inversion/cardiac cycle length) and an empirically derived cut-off of 0.34 did improve the specificity and predictive value (100% and 100%, respectively) without a significant loss of sensitivity (94%). We conclude that right atrial inversion, particularly if prolonged, is a useful echocardiographic marker of cardiac tamponade that may be of particular diagnostic value when the clinical picture is unclear.

270 citations

References
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Journal ArticleDOI
TL;DR: This specific abnormality of mitral leaflet movement represents the localization of dynamic outflow obstruction in hypertrophic obstructive cardiomyopathy.
Abstract: Simultaneous recordings of reflected ultrasound from the anterior mitral leaflet and left ventricular outflow, the ECG, the phonocardiogram, and a recording of the carotid artery pulse were obtained in six patients with hypertrophic obstructive cardiomyopathy. Abnormal sharp systolic anterior movement (SAM) of the mitral leaflet was observed. This movement began with the onset of ventricular ejection and reached a peak with the initial peak in the arterial pulse. The leaflet was apposed to the interventricular septum up to 60% of the ejection period. In the latter part of systole as the mitral leaflet moved away from the interventricular septum, the arterial pulse showed a second systolic wave. Onset of SAM coincided with onset of the systolic murmur. Spontaneous variations in amplitude of SAM coincided with alterations in contour of the arterial pulse and in the intensity of the murmur. Administration of methoxamine to four patients resulted in disappearance of SAM. In one patient following surgery, the ...

354 citations

Journal ArticleDOI
TL;DR: Recognition of the interventricular septal echoes represents an important contribution to echocardiography because these echoes can be a source of confusion when examining for pericardial effusion or mitral stenosis.
Abstract: A technic utilizing pulsed reflected ultrasound has been developed for estimating the size of both the right and left ventricles. The key to this technic is the recording of echoes from the interventricular septum. These echoes have been recognized previously but never have been described in any detail. With the septal echoes it is possible to obtain a right ventricular dimension between the echo originating from the anterior epicardial surface of the right ventricle to the right side of the interventricular septum. A left ventricular internal dimension is also obtainable between the left side of the septum and the echoes stemming from the endocardial surface of the posterior left ventricular wall. These ultrasound measurements were obtained during end-diastole in 26 normal subjects, 23 patients with atrial septal defects and large left to right shunts proved by cardiac catheterization and 12 patients with angiographically proved marked aortic or mitral regurgitation and dilated left ventricle. In the normal group the mean right ventricular dimension was 1.5 ± 0.4 cm. (range 0.5 to 2.1). The mean left ventricular dimension was 4.5 ± 0.5 cm. (range 3.5 to 5.3). The patients with the atrial septal defects had an increased mean right ventricular dimension of 3.7 ± 1.1 cm. (range 2.2 to 6.3), which differed significantly from the normal ( p p Besides facilitating measurements of the right and left ventricles, recognition of the interventricular septal echoes represents an important contribution to echocardiography because these echoes can be a source of confusion when examining for pericardial effusion or mitral stenosis. In addition, the location and motion of the interventricular septum introduces a new area of investigative and diagnostic possibilities for this increasingly popular technic.

267 citations

Journal ArticleDOI
01 Mar 1965-JAMA
TL;DR: Reflected ultrasound was found to be a highly effective and simple method of making this differential diagnosis of a large, dilated heart and pericardial effusion.
Abstract: The differentiation between a large, dilated heart and pericardial effusion is essential but frequently difficult. The clinician must often resort to diagnostic procedures which offer some hazard to the patient. The use of reflected ultrasound was found to be a highly effective and simple method of making this differential diagnosis. In five dogs with artificially produced pericardial effusion it was noted that without pericardial fluid only one ultrasound echo was produced in the vicinity of the posterior heart wall. When fluid was introduced, one detected two echoes, one which moved with cardiac action, the posterior heart wall, and another which moved only with respiration, the pericardium. The space between the two signals represented the pericardial fluid. Subsequent clinical studies confirmed the accuracy, reliability, and simplicity of this diagnostic procedure.

253 citations

Journal ArticleDOI
TL;DR: The basic abnormalities and variability in the degree of abnormality seen with echography of the left ventricular outflow tract are consistent with the proposed anatomy and pathophysiology of IHSS.
Abstract: Cardiac echography applied to diagnosis and therapy evaluation in idiopathic hypertrophic subaortic stenosis

209 citations

Journal ArticleDOI
TL;DR: By obtaining a true internal dimension of the left atrium rather than merely visualizing one or two of the chamber's external borders, this procedure is more accurate than routine cardiac fluoroscopy and chest roentgenograms.

190 citations