The document discusses echocardiographic evaluation of the pericardium. It describes the normal anatomy of the pericardium and physiology. Small amounts of pericardial fluid are normal but larger accumulations can indicate a pericardial effusion. Echocardiography is useful for diagnosing and characterizing pericardial effusions, identifying pericardial thickening, and evaluating conditions like cardiac tamponade and constrictive pericarditis. CT and MRI can provide additional information about pericardial abnormalities.
A lecture on the echocardiographic evaluation of hypertrophic cardiomyopathy. Starts with an overview of the topic then a systematic approach to diagnosis and then a differential diagnosis followed by take-home messages and conclusion.
A lecture on the echocardiographic evaluation of hypertrophic cardiomyopathy. Starts with an overview of the topic then a systematic approach to diagnosis and then a differential diagnosis followed by take-home messages and conclusion.
preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
ECHOCARDIOGRAPHIC EVALUATION OF MITRAL VALVE DISEASEPraveen Nagula
MITRAL VALVE ANATOMY , M MODE FINDINGS IN MITRAL STENOSIS,EVALUATION OF THE SEVERITY OF LESION,CALCIFIC MS,CCMA,CONGENITAL LESIONS,GUIDELINES ALL IN DETAIL....
Speckle tracking echocardiography (STE) is an echocardiographic imaging technique that analyzes the motion of tissues in the heart by using the naturally occurring speckle pattern in the myocardium or blood when imaged by ultrasound.
preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
ECHOCARDIOGRAPHIC EVALUATION OF MITRAL VALVE DISEASEPraveen Nagula
MITRAL VALVE ANATOMY , M MODE FINDINGS IN MITRAL STENOSIS,EVALUATION OF THE SEVERITY OF LESION,CALCIFIC MS,CCMA,CONGENITAL LESIONS,GUIDELINES ALL IN DETAIL....
Speckle tracking echocardiography (STE) is an echocardiographic imaging technique that analyzes the motion of tissues in the heart by using the naturally occurring speckle pattern in the myocardium or blood when imaged by ultrasound.
Carotid artery disease is commonly seen in association with atherosclerosis and complicate the situation. clearcut guidelines with necessary surgical details are provided in presentations.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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2. Anatomy of pericardium
• The normal pericardium consists of two layers: a fibrous outer layer
and a serous inner layer.
• The serous layer is a closed sac with the visceral component lining
the epicardium and the parietal component lining the fibrous outer
layer.
• The outer fibrous pericardium produces one of the most strongly
reflective or echo-producing areas of the heart, and it normally
moves anteriorly with the epicardium.
• The pericardium is reflected from the pulmonary veins as they
enter the left atrium. The fibrous component has attachments to
the sternum and to the diaphragm
3. • Pericardial fat is also commonly seen on two-dimensional (2D)
echocardiography
• Accumulation is most common in the interventricular and
atrioventricular grooves and on the right ventricular (RV) free wall.
• This normal but highly variable finding is most commonly seen
anterior to the heart in the parasternal long axis view and in the
subcostal views
• The best clues to its identity as fat are its absence posteriorly,
normal motion of the pericardium, and low intensity echoes (often
seen as faint linear striations) within the pericardial space.
4. Physiology
• In patients with a normal pericardium,
intrathoracic pressure decreases during
inspiration, leading to an increase in venous
return to the right heart and transient
increase in RV chamber size.
• Because the normal pericardium
accommodates the increased venous return
by expanding, this increase in venous return
does not impair left ventricular (LV) filling.
5. • When visualized on 2D echocardiography, the layers of the
pericardium appears as thin echogenic lines surrounding the
myocardium.
• The normal thickness of the visualized pericardial layers is less than
1 to 2 mm, but it can be difficult to make accurate measurements
on echocardiography due to motion throughout the cardiac cycle.
• In the normal healthy pericardium, there is less than 25 to 50 mL of
serous fluid in the pericardial sac formed by these layers .
• The interposition of this fluid between the pericardial layers results
in a very small physiological separation of the layers, best
appreciated on M-mode echocardiography only during systole
6. PERICARDIUM
• The normal pericardium is a fibroelastic sac
containing a thin layer of fluid that surrounds
the heart.
• When larger amounts of fluid accumulate
(pericardial effusion) or when the pericardium
becomes scarred and inelastic,
7.
8. • The pericardium consists of two layers that surround the
heart and proximal portions of the great vessels. The inner
layer, the visceral pericardium, is a thin membrane formed
by a single layer of mesothelial cells.
• The outer layer the parietal pericardium—a thick, fibrous
structure.
• A small amount (15–35 mL) of pericardial fluid separates
the two layers and serves a physiological lubricating
function. The fluid consists of a plasma ultrafiltrate
generated by the mesothelial lining of the pericardium and
is drained by the thoracic lymphatic system.
9. • Normally, a small amount of fluid (less than 25
to 50 mL) is contained within the closed sac of
the serous layer.
• Because of the pericardial reflection at the
level of the pulmonary veins, pericardial fluid
rarely accumulates in this area posterior to
the left atrium because the potential space
available decreases abruptly.
10.
11. Indications
• In general, transthoracic echocardiography (TTE) should be part of
the routine imaging evaluation in the following circumstances:
❖ All patients with suspected pericardial disease, including effusion,
constrictive pericarditis, or effusive-constrictive pericarditis.
❖ All patients with suspected bleeding into the pericardial space (eg,
trauma, perforation, post-operative).
❖ Follow-up study to evaluate recurrence of pericardial effusion
following treatment or to diagnose early constrictive pericarditis.
❖ Patients with pericardial friction rub developing in acute
myocardial infarction (MI) accompanied by symptoms such as
persistent pain, hypotension, and nausea.
12. Ventricular interdependence
• The mechanical restraint of the pericardium
contributes to ventricular interdependence: the LV
and right ventricle (RV) share a common wall in the
interventricular septum and are surrounded by the
relatively noncompliant pericardium.
• Therefore, the volume in one ventricle can influence
the diastolic pressure and filling characteristics of the
opposite chamber. This physiology is accentuated in
states of pericardial pathology
13. Acute pericarditis
• The echocardiogram is often normal in
patients with the clinical syndrome of acute
pericarditis unless it is associated with a
pericardial effusion, which is present in
approximately 60 percent of patients
• CMR is the preferred imaging method to
diagnose the pericardial inflammation seen in
pericarditis.
14.
15. Acute pericarditis
• Pericarditis is the most common affliction of the pericardium
and reflects inflammation that can result from abroad variety
of local and systemic disorders.
• Most causes can be assigned to one of six categories:
• infectious
• idiopathic
• metabolic
• collagen vascular/autoimmune
• postinjury
• neoplastic
16. A 32 year old female with fever ,
dyspnea on exertion and chest pain .
Diagnosis
17. Etiology
• Autoimmune disorders, including systemic lupus
erythematosus,rheumatoid arthritis, and scleroderma
may cause acute pericarditis as the first
manifestation of the systemic illness.
• Acute rheumatic fever can involve the pericardium as
part of a pancarditis.
• Certain drugs may cause pericarditis and/or pericardial
effusion either by inducing a lupus-like syndrome (e.g.,
hydralazine or procainamide), or by nonlupus,
unknown mechanisms
• (e.g., minoxidil, anthracycline antitumor agents).
19. Cardiac tamponade
• Cardiac tamponade, which may be acute or
subacute, is characterized by the
accumulation of pericardial fluid under
pressure.
• Variants include low pressure (occult) and
regional cardiac tamponade.
21. Constrictive pericarditis
• Constrictive pericarditis is the result of
scarring and consequent loss of elasticity of
the pericardial sac.
• Pericardial constriction is typically chronic,
but variants include subacute, transient, and
occult constriction.
22. Effusive-constrictive pericarditis
• Effusive-constrictive pericarditis is characterized by
underlying constrictive physiology with a coexisting
pericardial effusion, usually with cardiac tamponade.
• Such patients may be mistakenly thought to have only
cardiac tamponade
• Persistent elevation of the right atrial and pulmonary
wedge pressures after drainage of the pericardial fluid
points to the underlying constrictive process.
23. • Echocardiography is the initial method of choice for evaluating most
pericardial diseases, given its ability to provide both anatomic and
physiologic/hemodynamic information.
• When competently performed in patients with good acoustic
windows, echocardiography accurately detects pericardial effusions
and provides clinically relevant information about their size and
hemodynamic importance.
• The technique is less reliable than computed tomography (CT) for
detecting pericardial thickening/calcification, and both CT and
cardiac magnetic resonance (CMR) are superior for identifying small
loculated effusions.
• CMR is the preferred method to identify pericardial
inflammation/pericarditis.
28. Pericardial effusion
• Echocardiography has an important role in
diagnosing the presence of pericardial effusion,
estimating the size of the effusion, and evaluating
the hemodynamic importance of any effusion
• Key elements of the pericardial effusion which
should be described include
• size / Thickness
• location,
• circumferential versus loculated.
29. • Pericardial fluid appears on an echocardiogram as an echolucent space
between the pericardium and the epicardium.
• Small collections of pericardial fluid, which can be physiologic (25 to 50
mL), may be visible during ventricular systole. Effusions exceeding 25 to 50
mL are seen as an echo-free space throughout the cardiac cycle.
• Typically, a small (50 to 100 mL) free-flowing pericardial effusion is seen
posterior to the LV; this space diminishes and finally disappears as the
echo beam approaches the base of the LV and the left atrium
• Accumulation of pericardial fluid above the right atrium in the apical four
chamber view with the patient in the left lateral decubitus position is,
perhaps, the single most sensitive and specific indication of a pericardial
effusion
• However, in the case of a free flowing effusion, the site of accumulation
may be positional as there is gravity dependence. As the effusion
increases in size, it is typically seen anterior to the RV.
30.
31.
32. Quantification of effusion
• The size of a pericardial effusion is graded semi-
quantitatively, and when measured, it is measured in
diastole.
●Small effusions (50 to 100 mL) are only seen posteriorly,
typically less than 10 mm in thickness, and only cause
minimal separation between the epicardial (visceral)
pericardium and the thicker parietal pericardial sac.
●Moderate effusions (100 to 500 mL) tend to be seen along
the length of the posterior wall but not anteriorly; the
echo-free space is 10 to 20 mm at its greatest width.
●Large effusions (>500 mL) tend to be seen circumferentially
the echo-free space is greater than 20 mm at its greatest
width.
33.
34.
35. • The pericardial effusion should be described
as circumferential or loculated
• and transudative or exudative.
36. Loculated effusion and other
postoperative sequelae
Pericardial fluid ceases to be circumferential and
free flowing and becomes loculated or
compartmentalized as a result of a variety of
disease processes, most commonly following
cardiac surgery or following pericardial
hemorrhage.
Pericardial stranding, suggestive of fibrous
material within the pericardial effusion, is easily
seen on echocardiographic imaging, often as a
precursor to loculation of the effusion
37. • A loculated, eccentric effusion or localized hematoma
can produce regional cardiac tamponade in which only
selected chambers are compressed.
• Regional cardiac tamponade is most often seen after
pericardiotomy or MI.
• Clinical suspicion should be heightened in these
settings. Establishing the diagnosis is challenging and
may require additional echocardiographic views (eg,
subcostal or transesophageal) and other advanced
imaging techniques (eg, CT).
38. Differentiating between pleural and
pericardial effusions
• Left pleural effusions can present as large echo-free spaces
that resemble pericardial effusion
• These can be recognized because they appear as very large
posterior spaces often without any anterior component.
• Generally, in the parasternal long axis view, pleural
effusions are located posterior to the descending aorta,
while pericardial effusions are located anterior to the aorta.
• Additionally, pericardial effusions only rarely accumulate
posterior to the left atrium
39. Pericardial thickening and constrictive
pericarditis
Although pericardial thickening may be
appreciated on echocardiography, CMR and
CT are both superior techniques for detecting
pericardial thickening and for measuring the
thickness
CT is particularly beneficial for identifying
pericardial calcifications.
40. • If pericardial thickening fails to resolve, chronic pericardial
thickening with constrictive pericarditis can develop.
• Like cardiac tamponade, constrictive pericarditis is a
continuum of impairment of cardiac function that causes
restraint or restriction on ventricular filling sufficient to
raise filling pressures and decrease cardiac output or
cardiac reserve.
• One or more of the following echocardiographic findings
may be seen in patients with constrictive pericarditis
41.
42. Constrictive pericarditis
• Increased pericardial thickness with or without pericardial adhesion
(manifests as the absence of detectable motion between the layers
of the pericardium, which may be circumferential or occasionally
focal).
●Dilatation of the inferior vena cava and hepatic veins (plethora) with
absent or diminished inspiratory collapse.
●Moderate biatrial enlargement (although severe enlargement is more
compatible with restrictive cardiomyopathy).
●A sharp halt in ventricular diastolic filling (corresponding to the end
of early rapid diastolic filling as noted on Doppler).
43. ●Septal bounce with inspiratory motion of the interventricular septum
toward the LV.
●Abnormal filling of the ventricles during early diastole. An increased E
velocity of RV and LV inflow is seen due to the abnormally rapid
early diastolic filling associated with the combination of a small
ventricular volume and rapid recoil.
●Annular early diastolic (E') velocities are lower in constrictive
pericarditis secondary to surgery or radiation than in other
etiologies but are typically higher than in patients with restrictive
cardiomyopathy. The mitral annular lateral/medial E' ratio is
reversed in the majority of patients with constrictive pericarditis,
with the medial E' velocity being higher than the lateral E' velocity;
typically, this is referred to as "annulus reversus."
48. Minor respirophasic changes with left
ventricular filling in contrast with
marked respirophasic changes in right
ventricular filling in cardiac tamponade
55. IVC loss of normal respirophasic changes
less than50 percent decrease in IVC diameter
during inspiration
reflection of increased right atrial pressures
56. ❖ The propagation velocity of early diastolic transmitral flow on color M-mode is
normal or increased
❖ Pronounced respiratory variation in ventricular filling – Mitral inflow velocity falls
as much as 25 to 40 percent and tricuspid velocity greatly increases (>40 to 60
percent) in the first cardiac cycle following inspiration. The respiratory variation in
pulmonary venous flow is even more pronounced . These phenomena, which are
manifestations of ventricular interdependence, are not present in either normal
subjects or patients with restrictive cardiomyopathy.
❖ Hepatic venous flow reversal increases with expiration, reflecting the ventricular
interdependence and the dissociation of intracardiac and intrathoracic pressures.
❖ As with the distinction between cardiac tamponade and pericardial effusion, there
can be significant overlap between the findings in frank constriction and those in
extensive pericardial thickening without hemodynamic compromise.
57. • Partial or complete absence of the pericardium
may be suspected but cannot usually be
definitively diagnosed by echocardiography,
although most echocardiographic findings are
non-specific. The orientation and distance
between the transducer and the posterior wall on
TTE have been suggested as diagnostic
parameters, but in general, MRI and CT are
preferred for visualizing the pericardium and
confirming the diagnosis [1,12]. Typical findings
on echocardiography include:
58. Absence of pericardium
• In patients with complete absence of the
pericardium, echocardiography may visualize
more of the RV than typically seen on routine left
parasternal echocardiogram, which is due to
enlargement of the RV, excessive motion of the
posterior LV wall, and shift of the heart to the
left.
• These changes may result in paradoxical motion
of the interventricular septum. All of these
findings mimic RV volume overload as seen in
atrial septal defect or tricuspid insufficiency
59. • In patients with partial absence of the
pericardium who have herniation of a chamber,
echocardiography may show a wall motion
abnormality along the line of demarcation.
• If the pericardial defect is left sided, it is the left
atrial appendage that is most likely involved.
However, if a coronary artery is compressed, a
true wall motion abnormality may indeed exist.
• Rare instances of sudden death and acute
ischemia resembling an acute ST elevation MI
have been reported
60. • No specific treatment is required for most patients
with complete congenital absence of the pericardium,
as such patients appear to have a normal life
expectancy.
• Partial defects may lead to herniation in which case
surgery is indicated. The pericardium can be removed if
the defect is large or closed if it is a smaller defect.
• Surgery in the absence of herniation can be
considered if the patient is symptomatic, while
occasionally prophylactic closure to prevent future
herniation is indicated.
62. Pericardial cyst
• Pericardial cysts which typically occur along the right heart border
but can occur anywhere, are generally asymptomatic, causing
symptoms only if adjacent structures (eg, coronary arteries) are
impacted.
• The primary clinical relevance of pericardial cysts relates to
distinguishing the cyst from other cardiac and mediastinal masses.
• The presence of a pericardial cyst is usually suggested by the chest
radiograph.
• Pericardial cysts, which echocardiographically appear as an echo-
free space that is more localized and spherical than a pericardial
effusion , are difficult to detect with TTE, although they may be
more readily visualized with transesophageal echocardiography