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El derrame pleural como causa del colapso diastólico del ventrículo derecho
1Department of Medicine, Bowman Gray School of Medicine, Winston-Salem, NC 27157-1045.
Circulation
|August 1, 1992
Resumen
Las grandes efusiones pleurales pueden imitar el tamponado cardíaco al causar colapso diastólico ventricular derecho (CVDR). Este estudio muestra que la RVDC puede ocurrir con derrames pleurales, lo que puede conducir a un diagnóstico erróneo y un tratamiento incorrecto del tamponado cardíaco.
Área de la Ciencia:
- Cardiología Cardiología.
- Medicina de cuidados críticos Medicina de cuidados críticos.
- Imágenes de diagnóstico por imágenes.
Sus antecedentes:
- El colapso diastólico ventricular derecho (CVDR) es un marcador ecocardiográfico no invasivo para el tamponamiento cardíaco.
- Las grandes efusiones pleurales bilaterales pueden elevar la presión intrapericárdica.
- Esto puede conducir a un diagnóstico falso positivo de tamponamiento cardíaco.
Objetivo del estudio:
- Investigar si los grandes derrames pleurales pueden inducir el CVDR.
- Para determinar si el RVDC de los derrames pleurales imita el tamponamiento cardíaco.
- Para diferenciar la RVDC causada por efusiones pleurales frente a las pericárdicas.
Principales métodos:
- Siete perros fueron instrumentados para medir los parámetros hemodinámicos.
- La RVDC fue inducida por la infusión de solución salina en los espacios pericárdico y luego pleural.
- Ecocardiografía bidimensional monitoreada para el inicio de RVDC.
Principales resultados:
- RVDC ocurrió en presiones intrapericárdicas y auriculares derechas similares para ambos tipos de efusión.
- El inicio de la RVDC ocurrió durante la expiración con efusiones pericárdicas e inspiración con efusiones pleurales.
- Las efusiones pleurales preservaron el gasto cardíaco y la presión aórtica mejor que las efusiones pericárdicas.
Conclusiones:
- Las grandes efusiones pleurales bilaterales pueden elevar la presión intrapericárdica, causando RVDC.
- Este hallazgo puede conducir a un diagnóstico falso positivo de tamponamiento cardíaco.
- El diagnóstico erróneo puede dar lugar a intervenciones terapéuticas inadecuadas.
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