Cardiac Motion in Patients with Pericardial Effusion

Diagnostic ultrasound was used to record the movement of the anterior and posterior heart walls in 23 patients with proven pericardial effusion. Fifteen of these patients demonstrated heart-wall motion that could not be distinguished from the normal pattern. Two patients with acute cardiac tamponade exhibited markedly reduced cardiac motion. The ultrasoundcardiograms obtained from the remaining six patients indicated posterior displacement of the entire heart during systole. The extent of this cardiac displacement varied. Five of the six patients with excessive cardiac motion had malignant pericardial effusion, and four of the six had clinical evidence of cardiac tamponade. The two patients with the most marked excursions exhibited electrical alternation.The results of this study substantiate the theory that excessive cardiac motion may occur in some patients with pericardial effusion. Objective evidence is also provided in support of the positional etiology of electrical alternation associated with pericardial effusion. An attempt is made to identify some of the factors responsible for the observed abnormal cardiac motion, and some speculation is offered as to what role rotation might play in the cardiac displacement.This study also serves as an example of the type of cardiovascular investigation that can be performed with diagnostic ultrasound.