Diagnostic Signs in Compressive Cardiac Disorders

Abstract

Thirty patients with primary cardiac compression due to constrictive pericarditis, lax effusion or cardiac tamponade were studied. An additional 7 cases are presented with spurious evidence of cardiac compression or with pericardial effusion playing an unimportant role in the circulatory disorder. Rather stringently de-finded physical findings were sought which might allow discrimination between cardiac disorders. The following conclusions are drawn from the results. Constrictive pericarditis is associated with venous and auscultatory phemonena which do not allow separation from other forms of heart disease causing congestive heart failure. Kussmaul''s sign is present in less than 40%; pulsus paradoxus as classically defined is rare. With lax pericardial effusion, Kussmaul''s sign and Friedreich''s sign along with 3rd heart sounds, are not present. Pulsus paradoxus is inconstant. Circulatory distress is not apparent. Tamponade induces signs of circulatory distress and is regularly characterized by pulsus paradoxus but Friedreich''s sign, a 3rd heart sound, as well as Kussmaul''s venous sign, are absent. The venous pressure exceeds 12 mm Hg. There is an inspiratory decrease in venous pressure and pericardial pressure. The low cardiac index is usually relieved by tap. Spurious signs of cardiac compression may be due to: respiratory disease; severe myocardial disease and incidental effusion or, obesity. In the first case there is pulsus paradoxus, normal cardiac index, low venous pressure, and venous and pericardial pressure decrease with inspiration. The second group does not show pulsus paradoxus and the elevated venous pressure, diastolic dip and 3rd heart sounds are due to heart failure. Obesity may cause pulsus paradoxus and increased peripheral venous pressure, which does not reflect central venous pressure. These findings seem related to inspiratory collapse of extra-athoracic vessels.