A.4. What is the difference between acute and delayed cardiac tamponade?
Answer:
Normal adult pericardial reserve is limited to acute increases in volume of 150 to 250 mL. Further acute increases in pericardial volume will cause dramatic changes in intrapericardial pressure. In slowly accumulating effusions, the pericardium can remodel and stretch, thereby increasing its capacitance (Figure 12.1). Massive, slowly accumulating pericardial effusions therefore can exist with little to no clinical evidence of cardiac tamponade.
Figure 12.1.: Acute Versus Delayed Cardiac Tamponade.
Acute versus delayed cardiac tamponade. In acute effusions, normal pericardium has a reserve volume of 150 to 250 mL. Until this volume is exceeded, intrapericardial pressure remains relatively low. Beyond this reserve, pericardial pressure rises until the limit of pericardial compliance is met. Once this inflection point is reached, pericardial pressure rises rapidly, which clinically corresponds to cardiac tamponade as cardiac structures become compressed. In slowly accumulating effusions, the pericardium remodels and increases its mass and surface area, thereby increasing its overall compliance. This increases pericardial reserve volume relative to rapidly growing effusions. (From Imazio M, Adler Y. Management of pericardial effusion. Eur Heart J. 2013;34:1186-1197. Copyright © 2012 The Author. Adapted by permission of Oxford University Press.)
References
- Imazio M, Adler Y. Management of pericardial effusion. Eur Heart J. 2013;34:1186-1197.
- Leiva EH, Carreño M, Bucheli FR, Bonfanti AC, Umaña JP, Dennis RJ. Factors associated with delayed cardiac tamponade after cardiac surgery. Ann Card Anaesth. 2018;21:158-166.
- LeWinter MM. Pericardiectomy to treat heart failure with preserved ejection fraction: unrestrained enthusiasm? Circ Heart Fail. 2017;10:e003971.