Abnormal wall movements of the right ventricle and both atria in patients with pericardial effusion as indicators of cardiac tamponade

A retrospective study on 126 patients with pericardial effusionshowed cardiac tamponade to be present in 39 patients and absentin 87. We evaluated the distribution of the pericardial effusionas well as the effect of hydrodynamic compression on the differentheart chambers. Small to large volumes of pericardial fluidwere found in both groups of patients. Abnormal wall movementswere only present if pericardial effusion was adjacent. Hydrodynamiccompression signs consisted of abnormal wall movements of bothatria at enddiastole continuing into systole, and of the rightventricle in early- and mid-diastole. Most of the patients withcardiac tamponade showed an abnormal motion pattern of bothright atrium and ventricle (13 patients) or of the right atrialwall alone (12 patients). Abnormal motion of the right ventriclealone was seen in 6 patients, of both atria and right ventriclein 4 and of the left atrium alone in 1 patient. False-negativediagnoses of cardiac tamponade occurred in 3 of the 39 patientsand false-positives in 2 of the 87 (sensitivity 92%, specificity98%). Measurements of the duration of the inversion of bothatria increased the specificity of these abnormal wall movementsto 100%. Echocardiography can help to identify those patientswho are clinically at risk and need pericardial drainage.