The Hemodynamics of Pericardial Constriction

Pericardial constriction results in elevation and near equalization of the right atrial, right ventricular diastolic and left ventricular diastolic pressures. Intracardiac pressure recordings from a patient with pericardial constriction are presented.

Images in this series

Simultaneous Recording of the Right Atrial and Left Ventricular Pressures in a Patient with Pericardial Constriction

by: Joe B. Calkins, Jr., M.D., F.A.C.C., F.A.C.P., F.A.S.E.

Right atrial (RA) and left ventricular (LV) diastolic pressures are elevated and nearly equal in this patient with pericardial constriction. The right atrial A and V pressures are 26 mm Hg and the left ventricular end diastolic pressure is 28 mm Hg. Prominent X and Y descents are present in the right atrial waveform, resulting in the characteristic M- or W-shaped appearance.

Simultaneous Recording of the Right and Left Ventricular Pressures in a Patient with Pericardial Constriction

by: Joe B. Calkins, Jr., M.D., F.A.C.C., F.A.C.P., F.A.S.E.

Right ventricular (RV) and left ventricular (LV) pressures are elevated and nearly identical in this patient with pericardial constriction. Ventricular filling occurs rapidly during early diastole and then stops abruptly when the intracardiac volume reaches the limit set by the constricting pericardium. The resulting “dip and plateau” configuration of the ventricular waveforms or the “square root sign” is best seen in the longer diastole following a premature beat (arrows).

Simultaneous Recording of the Right and Left Ventricular Pressures in a Patient with Pericardial Constriction

by: Joe B. Calkins, Jr., M.D., F.A.C.C., F.A.C.P., F.A.S.E.

Early diastolic ventricular filling followed by an abrupt cessation of flow across the mitral and tricuspid valves when ventricular volumes reach the limit set by the constricting pericardium result in the “dip and plateau” configuration of the ventricular waveforms or the “square root sign”. This finding is often best seen during the longer diastole following a premature beat (arrows).