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Video 21: Subcostal four chamber in a patient with pericardial effusion and tamponade.

Video Author: Dr. Josh Zimmerman, MD, FASE
Published on: 02.17.2017
Associated with: Anesthesia & Analgesia. 124(3):753-760, March 2017

Subcostal four chamber in a patient with pericardial effusion and tamponade. The effusion is seen as a large echolucent space around the heart. The right atrium appears collapsed in ventricular systole and the right ventricle appears compressed in ventricular diastole. These findings are both consistent with tamponade physiology.

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A ME long axis view and a ME four chamber view are selected and analyzed using the Cardiac Motion Quantification (CMQ) analysis software package. First the aortic valve closure is identified and aortic valve closure time set. The ME four chamber is then selected and the LV long axis strain model is applied to the RV to allow correct labeling of septal segments. Tracking is qualitatively assessed and manually adjusted to capture the myocardium. The RV is divided into seven segments and the global strain is measured at – 29.8% with regional peak variability with all segments within limits of normal. RV Septum is de-selected to obtain RV free wall strain that is measured at -31.4%.
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