Cardiac tamponade is the phenomenon of hemodynamic compromise caused by a pericardial effusion. Following a myocardial infarction, the most common causes of pericardial fluid include early pericarditis, Dressler's syndrome, and hemopericardium secondary to a free wall rupture. On transthoracic echocardiography, pericardial fluid appears as an echo-free space in between the visceral and parietal layers of the pericardium. Pericardial fat has a similar appearance on echocardiography and it may be difficult to discern the two entities. We present a case of a post-MI patient demonstrating pseudo tamponade physiology in the setting of excessive pericardial fat.
Cardiac tamponade is the phenomenon of hemodynamic compromise caused by a pericardial effusion. There are a myriad of etiologies for pericardial effusions, including infectious, immune-mediated, and malignancy related causes. Following a myocardial infarction (MI), pericardial effusions can be caused by pericarditis, free wall rupture, or as a complication of percutaneous procedures [1]. The most efficient technique to diagnose cardiac tamponade is by transthoracic echocardiography (TTE). Pericardial effusions are detected as a lucent separation of parietal and visceral pericardium. Echocardiographic findings suggestive of tamponade physiology include early right ventricular (RV) diastolic collapse, right atrial (RA) systolic collapse, and respiratory variation greater than 40% across the mitral valve [2].
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