Predictors for the Diagnosis of Cardiac Tamponade in Patients with Pericardial Effusion

A controversial echocardiographic report is usually a warning alert about hemodynamic derangement; however, tamponade is almost always a clinical diagnosis which needs supplementation of echocardiographic finding. This study presents the diagnosis of cardiac tamponade in patients with pericardial effusion through clinical and echocardiographic (ECHO) assessment. Data for 72 patients were retrieved from case notes from King Fahad Cardiac Center (KFCC) from May 2015 to May 2019. Two-dimensional, M-mode, and Doppler readings were taken for every patient due to clinical instability. The diagnostic accuracy of different markers was measured with sensitivities, specificities, positive predictive values (PPV), and negative predictive values (NPV) via SAS/STATA software. Muffled heart sound, which is one of the criteria for tamponade was absent in 90% (n = 65) patients, while positive in only 10% (n = 7) patients. Echocardiographic examination pointed out the collapse of the right, atrium, or/and ventricle in 30 (42%) patients, whereas 42 (58%) patients had no collapse. The clinical Tamponade Risk Score (TRS) of more than 3 is highly suggestive of tamponade with a specificity of 100%, sensitivity of 76%, positive predictive value 100%, and negative predictive value of 88%. Findings indicated and corroborated conventional 2D ECHO can confirm the presence of pericardial effusion and evaluate the rise in intra-pericardial pressure by assessing the right heart chamber partial collapse even before blunting of hemodynamic parameters and settling clinical cardiac tamponade.