Cohen M L
Department of Medicine, New York University Medical Center, New York 10016.
J Appl Physiol (1985). 1990 Sep;69(3):924-31. doi: 10.1152/jappl.1990.69.3.924.
Seven episodes of experimental cardiac tamponade were induced in five anesthetized closed-chest dogs. Simultaneous pericardial and intracavitary pressures were synchronized with superior vena caval and transvalvular pulsed-Doppler flow tracings. The earliest indication of tamponade was the development of a negative transmural right atrial pressure that occurred during early ventricular diastole and was associated with echocardiographic evidence of right atrial collapse. This was also associated with reversal of diastolic flow in the superior vena cava and with diminished early diastolic flow velocity across the tricuspid as well as the mitral valve. During more advanced cardiac tamponade, the transmural right atrial pressure became negative during both early and late ventricular diastole as well as during isovolumic ventricular systole. This was associated with a disappearance of early diastolic ventricular filling and right ventricular diastolic collapse as observed on two-dimensional echocardiography. In hypotensive cardiac tamponade (cardiac output diminished by 70%), the decreased transmural right atrial pressure that developed during ventricular systole was accompanied by diminished antegrade flow in the superior vena cava. In advanced and hypotensive tamponade, ventricular filling occurred mainly during atrial contraction.
在五只麻醉的开胸犬身上诱发了七次实验性心脏压塞。同时将心包压力和心腔内压力与上腔静脉和跨瓣脉冲多普勒血流描记图同步。心脏压塞的最早迹象是在心室舒张早期出现的负性右心房跨壁压，这与右心房塌陷的超声心动图证据相关。这也与上腔静脉舒张期血流逆转以及三尖瓣和二尖瓣舒张早期血流速度降低有关。在更严重的心脏压塞期间，右心房跨壁压在心室舒张早期和晚期以及等容心室收缩期均变为负值。这与二维超声心动图上观察到的舒张早期心室充盈消失和右心室舒张期塌陷有关。在低血压性心脏压塞（心输出量减少70%）中，心室收缩期出现的右心房跨壁压降低伴随着上腔静脉顺行血流减少。在严重和低血压性心脏压塞中，心室充盈主要发生在心房收缩期。
