Case vignette
57yo M with AML on chemo p/w SOB, gradually worsening over 2wks. He cannot walk to the bathroom and feels lightheaded.
BP 103/76, HR 120, RR 18, SpO2 91%, T 36.4.
Cachectic, dyspneic male with +JVD, muffled heart sounds, and BLE edema.
Labs: WBC 0.8 (neutrophils 0.39), Plts 0, Hgb 5.9.
What do you see?
CP2 US1: RV diastolic collapse, RA systolic collapse, Man bouncing on trampoline sign, underfilled/hyperdynamic LV
CP2 US2: RV collapse, RA collapse, septal bounce, underfilled/hyperdynamic LV
What do you do next?
Transfusion initiated. Cardiology consulted but is unsure if patient has tamponde. A radiology-performed US is completed and agrees the patient has tamponade. Patient admitted to cath lab for emergent pericardiocentesis.
Teaching points. The following POCUS findings are concerning for tamponade:
RA systolic collapse (sensitive)
RV diastolic collapse (specific)
Plethoric IVC (>2cm with <50% respiratory variation) (sensitive, except in cases of severe hypovolemia)
Systolic "bounce" (or interventricular dependence for advanced users)
"Man jumping on trampoline" or "John Travolta Sign" (wiggling of RV due to impaired diastolic filling)
MV inflow variation > 25%, TV inflow variation > 40% (best performed using apical 4C, pulse wave doppler)
Residents/staff: Dr. Ramsey Selbak
Tamponade