Education  |   November 2018
Images in Anesthesiology: Early Identification of Tamponade Using Focused Cardiac Ultrasound
Author Notes
  • From the Department of Anesthesia, Division of Critical Care, University of Michigan Medical School, Ann Arbor, Michigan.
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Address correspondence to Dr. Sigakis: msigakis@med.umich.edu
Article Information
Education / Images in Anesthesiology / Cardiovascular Anesthesia / Radiological and Other Imaging
Education   |   November 2018
Images in Anesthesiology: Early Identification of Tamponade Using Focused Cardiac Ultrasound
Anesthesiology 11 2018, Vol.129, 1025. doi:10.1097/ALN.0000000000002283
Anesthesiology 11 2018, Vol.129, 1025. doi:10.1097/ALN.0000000000002283
CARDIAC tamponade can be difficult to diagnose because clinical and electrocardiogram findings have low sensitivity and specificity. Intubation and positive pressure ventilation during unrecognized tamponade can lead to hemodynamic instability from decreased venous return and increased right ventricular afterload, compromising right ventricular stroke volume. Focused cardiac ultrasound can rapidly demonstrate sensitive and specific findings of tamponade.1  The increased availability, noninvasiveness, portability, and rapid acquisition of images have made focused cardiac ultrasound an indispensable perioperative tool.2,3 
These focused cardiac ultrasound images demonstrate pericardial tamponade in an adult patient with progressive respiratory distress one week after cardiac surgery. The subcostal four-chamber view revealed a pleothoric inferior vena cava (IVC; fig. 1A), circumferential fluid (fig. 1, B and C), late diastolic inversion of the right atrial (RA) free wall (fig. 1B), right ventricular (RV) diastolic collapse (fig. 1C), and a “swinging heart,” which describes cardiac chambers floating within the pericardial space in a phasic manner (LA = left atrium; LV = left ventricle; x = probe orientation marker), (Supplemental Digital Content, http://links.lww.com/ALN/B730). Given echocardiographic evidence, it is often prudent to perform emergent pericardiocentesis before induction of anesthesia, tracheal intubation, and positive pressure ventilation to avoid cardiorespiratory morbidity.