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Transient Systolic Dysfunction after Relief of Cardiac Tamponade

Mark W. Wolfe, MD; and Elazer R. Edelman, MD, PhD
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From Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Requests for Reprints: Mark W. Wolfe, MD, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. Acknowledgments: The authors thank Dr. Richard T. Lee for editorial review of this manuscript and Dr. Campbell Rogers for help in obtaining data on the second patient.


Copyright 2004 by the American College of Physicians


Ann Intern Med. 1993;119(1):42-44. doi:10.7326/0003-4819-119-1-199307010-00007
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Cardiac tamponade is known to directly affect the diastolic function of the myocardium, but no cases have been reported in which systolic function was affected. We describe two patients with malignant pericardial effusions and previously normal left ventricular function in whom marked reductions in left ventricular systolic function developed after the relief of tamponade by pericardiocentesis. The patients received serial follow-up with transthoracic echocardiography, which documented a progressive return to normal systolic function in the absence of further intervening therapy. These two cases suggest that cardiac tamponade may transiently affect systolic function. Potential pathophysiologic mechanisms include changes in coronary blood flow and sympathetic tone induced by tamponade.

Figures

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Figure 1.
Ejection fraction over time in two patients.

Ejection fraction was calculated as (end diastolic volume end systolic volume)/end diastolic volume; volumes were measured for 5 consecutive cardiac cycles and calculated by the disc summation method (that is, the modified Simpson rule).

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