The hemodynamic effects of cardiac tamponade: mainly the result of atrial, not ventricular, compression.

Abstract

We studied the hemodynamic effects of surgically induced regional cardiac tamponade in anesthetized dogs. Tamponade restricted to either the right or the left ventricle was compared with tamponade of either ventricle and both atria. Intrapericardial pressures were elevated to approximately 20 mm Hg. With tamponade of the right ventricle alone, aortic pressure rose from 161 +/- 3.8 to 164 +/- 3.4 mm Hg (p greater than .05) and cardiac output fell from 149.4 +/- 16.1 to 134.9 +/- 11.9 ml/kg/min (p greater than .05). However, tamponade of the right ventricle plus both atria decreased mean aortic pressure from 152.5 +/- 3.6 to 115.9 +/- 8.7 mm Hg (p less than .01) and cardiac output fell from 118 +/- 14.8 to 38.9 +/- 4.8 ml/kg/min (p less than .01). With tamponade of the left ventricle alone, aortic mean pressure changed significantly from 158.5 +/- 6.1 (control) to 148.9 +/- 5.0 mm Hg (tamponade) (p less than .05) and cardiac output was 135.5 +/- 28.3 (control) and 111 +/- 24.7 ml/kg/min (tamponade) (p greater than .05). However, when the atria were included, mean aortic pressure fell significantly more from 155.5 +/- 5.4 to 105.5 +/- 10.4 mm Hg (p less than .01) and cardiac output fell from 142.2 +/- 16 to 47.8 +/- 6.4 ml/kg/min (p less than .01). Atrial pressure rose when the atria were included, but not with tamponade of the left ventricle alone. Right but not left atrial pressure rose slightly with isolated right ventricular tamponade. We conclude that the principal hemodynamic effects of cardiac tamponade are not the result of compression of either the right or the left ventricle, but are the consequence of compression of the atria and/or the venae cavae and the pulmonary veins.