Umeno T, Ishibashi Y, Ohta T, Sano K, Izumi S, Morioka S, Nosaka H, Moriyama K
Matsue Municipal Hospital.
J Cardiol. 1993;23(1):107-12.
A case of cardiac tamponade showing the characteristic flow pattern in the superior vena cava is reported. An 80-year-old man was admitted to our hospital complaining of anorexia and general fatigue. We observed a paradoxical pulse of 25 mmHg, dilatation of the jugular vein, and marked cardiomegaly on chest radiography. A two-dimensional echocardiogram demonstrated a massive pericardial effusion and collapse of the right atrial and right ventricular walls. On the basis of his echocardiograms and clinical signs, we diagnosed his condition as cardiac tamponade. Pulsed Doppler echocardiograms showed two-peaked flow in the superior vena cava in systole. To assess the diagnostic significance of this characteristic flow pattern, the superior vena cava flow was recorded simultaneously with the intrapericardial pressure and the right atrial pressure. The intrapericardial pressure was higher than the right atrial pressure in early systole. After pericardial drainage, these pressures became reversed and the two-peaked flow disappeared. The two-peaked flow is attributed to collapse of the right atrial wall caused by the higher intrapericardial pressure than the right atrial pressure. The superior vena cava flow represents the right heart filling dynamics in cardiac tamponade.
报道了一例显示上腔静脉特征性血流模式的心包填塞病例。一名80岁男性因厌食和全身乏力入院。我们观察到25 mmHg的奇脉、颈静脉扩张以及胸部X线片上明显的心脏扩大。二维超声心动图显示大量心包积液以及右心房和右心室壁塌陷。根据他的超声心动图和临床体征，我们将他的病情诊断为心包填塞。脉冲多普勒超声心动图显示收缩期上腔静脉内血流呈双峰。为评估这种特征性血流模式的诊断意义，同时记录了上腔静脉血流、心包内压力和右心房压力。在心包引流前，收缩早期心包内压力高于右心房压力。心包引流后，这些压力关系逆转，双峰血流消失。双峰血流归因于心包内压力高于右心房压力导致的右心房壁塌陷。上腔静脉血流代表了心包填塞时右心的充盈动态。
