Pericardium
Constriction vs restriction is a favourite exam question so you need to know it.
Pericardial effusion in PLAX will extend just into gap between LA and descending aorta. It is anterior to the aorta and won’t extend behind the LA.
A pleural effusion will lie behind the aorta and around the LA.
Measure effusion in diastole in different views and note location (generalised or localised).
Drain if:
- Tamponade
- Suspected infection
- Large
Hole in myocardium but blood contained by pericardium.
Neck width <1/2 width of aneurysm
True aneurysm
Dead myocardium which dilates. Wide neck and wide diameter.
Tamponade
2D and M-mode.
Look for chamber collapse in diastole.
RA then RVOT then whole RV then LA then LV.
RAP will be high so IVC dilated with little or no respiratory variation.
PW
Assess RV and LV inflow in A4C. Inspiration increases flow of blood into R heart (sucks it in) and reduces flow into L heart (pulmonary vessels expand). This is exaggerated in tamponade (pulsus paradoxus). Measure max and minimum E wave velocities for each valve.
Assess outflow of RVOT and LVOT by measuring Vmax and/or VTI.
Constrictive Pericarditis vs restrictive cardiomyopathy.
