A case of a 62-year-old man with a large pericardial effusion is presented. He developed clinical signs of cardiac tamponade. Two-dimensional echocardiography revealed collapse of the right ventricle in early diastole and inversion of the free wall of both atria in systole. Pulsed Doppler echocardiography demonstrated an abnormally increased respiratory variation in transvalvular blood flow velocities. Expiration caused an increase in the flow velocities across the mitral and aortic valves, and a decrease in the flow velocity across the tricuspid valve. The exaggerated respiratory variations in transvalvular flow velocities suggest that Doppler evaluation may be a valuable adjunct in the diagnosis of cardiac tamponade.

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