Is it possible to separate ischemic and bleeding risk in patients with non-ST segment elevation acute coronary syndromes?

ferential pericardial effusion with features consistent with tamponade. Color Doppler-flow examination revealed flow within the anterior portion of the pericardial effusion directed toward the right ventricle in systole and toward the right atrium in diastole. No communication with the right atrium or right ventricle was seen [1]. The intrapericardial flow pattern could also be demonstrated by pulsed-wave Doppler examination. The authors hypothesize that in their case, probably secondary to anticoagulation, the viscosity of the pericardial fluid was low enough to demonstrate, by way of fluid shifts within the confines of the pericardium, the changes of volume and pressure of the heart chambers throughout the cardiac cycle. Nevertheless, the small amount of effusion can be commonly seen in post-radiofrequency ablation, which should be general fluid without red blood cells and could not generate Doppler signal. In our case, the patient has only a small amount pericardial effusion. The flow was clearly demonstrated by color and pulse Doppler which might be due to mild injury around the pulmonary vein during radiofrequency ablation operation. The absence of red blood cells prevents the reflection of the ultrasound beam and, therefore, generates a Doppler signal. This case indicated that in patients with pericardial effusion postprocedure, we should pay more attention to find if there is any flow signal by color and pulse Doppler, which can early detect the communication between chambers and pericardium.