DOPPLER-ECHOCARDIOGRAPHY IN CARDIAC-TAMPONADE AND CONSTRICTIVE PERICARDITIS

Doppler echocardiography has greatly facilitated the assessment of pat ients with compressive cardiac disease. Patients in whom cardiac tampo nade or pericardial constriction are suspected should undergo a comple te echocardiographic examination including careful Doppler analysis of transmitral flow and inflow through the hepatic vein or superior vena cava (SVC). Monitoring of both the electrocardiogram and the phase of respiration are an integral part of this examination. Patients with c ardiac tamponade exhibit a > 25% reduction in E wave velocity during t he first inspiratory cardiac cycle; they exhibit predominant systolic inflow through the hepatic vein or SVC (with a predominant X descent w ith little or no Y descent). In constrictive pericarditis the pattern of transmitral flow variation is comparable to that observed in cardia c tamponade, however, a prominent Y descent is often observed on hepat ic vein or SVC Doppler study. Similar changes with respiration may be observed in mitral inflow in obese patients or in those with chronic o bstructive pulmonary disease, however, in these conditions the nadir o f E wave velocity is observed 2-3 cardiac cycles after the first inspi ratory beat. Restrictive cardiomyopathy may produce a similar systemic venous flow pattern, but increased inspiratory flow reversals and lac k of respiratory variation in transmitral flow velocity distinguish it from constrictive pericarditis.