| Raised systemic venous pressure*, hypotension†, pulsus paradoxus‡, tachycardia§, dyspnoea or tachypnoea with clear lungs |
| Drugs (cyclosporin, anticoagulants, thrombolytics, etc), recent cardiac surgery, indwelling instrumentation, blunt chest trauma, malignancies, connective tissue disease, renal failure, septicaemia¶ |
| Can be normal or non-specifically changed (ST-T wave), electrical alternans (QRS, rarely T), bradycardia (end stage), electromechanical dissociation (agonal phase) |
| Enlarged cardiac silhouette with clear lungs |
| Diastolic collapse of the (1) anterior RV free wall**, RA collapse, LA and rarely LV collapse, increased LV diastolic wall thickness “pseudohypertrophy”, VCI dilatation (no collapse in inspirium), “swinging heart” |
| Tricuspid flow increases and mitral flow decreases during inspiration (reverse in expiration) |
| Systolic and diastolic flows are reduced in systemic veins in expirium and reverse flow with atrial contraction is increased |
| Large respiratory fluctuations in mitral/tricuspid flows |
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Confirmation of the diagnosis and quantification of the haemodynamic compromise:
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–RA pressure is raised (preserved systolic x descent and absent or diminished diastolic y descent)
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–Intrapericardial pressure is also raised and virtually identical to RA pressure (both pressures fall in inspiration)
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–RV mid-diastolic pressure raised and equal to the RA and pericardial pressures (no dip-and-plateau configuration)
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–Pulmonary artery diastolic pressure is slightly raised and may correspond to the RV pressure
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–Pulmonary capillary wedge pressure is also raised and nearly equal to intrapericardial and right atrial pressure
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–LV systolic and aortic pressures may be normal or reduced
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Documenting that pericardial aspiration is followed by haemodynamic improvement††
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Detection of the coexisting haemodynamic abnormalities (LV failure, constriction, pulmonary hypertension)
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Detection of associated cardiovascular diseases (cardiomyopathy, coronary artery disease)
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| Atrial collapse and small hyperactive ventricular chambers |
| Coronary compression in diastole |