Final The Echo Manual DIGITAL

Chapter 12 Pericardial Diseases

CHAPTER 12 PERICARDIAL DISEASES

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FIGURE 12-8 A: Left , 2-D and M-mode echocardiogram of plethoric inferior vena cava ( IVC ), which is present in most of patients with cardiac tampon- ade. Right , M-mode echocardiogram from the parasternal window in a patient with cardiac tamponade and a large circumferential pericardial effusion ( PE ). The M-mode was recorded simultaneously with the respirometer tracing at the bottom ( upward arrow , onset of inspiration; downward arrow , onset of expiration). The left ventricular dimension during inspiration becomes smaller than with expiration. The opposite changes occur in the right ventricle. The ventricular septum moves toward the LV with inspiration and toward the RV with expiration, accounting for the abnormal ventricular septum in patients with cardiac tamponade. B: A subcostal view of a plethoric IVC ( upper left ), M-mode of RV-free wall with early diastolic collapse ( arrow in lower left ), hepatic vein Doppler showing diastolic flow reversals with expiration ( arrow in upper right ), and mitral inflow velocity with respiratory variation ( lower right ). Note that mitral E velocity is lower than A velocity in most of patients with pure tamponade. :R O W H U V . O X Z H U , Q F 8 Q D X W K RU L ] H G U H S U R G X F W L R Q R I W K H FRQW

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