Cardiac tamponade physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
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====Pulsus Paradoxus==== | ====Pulsus Paradoxus==== | ||
The following video depicts and explains the concept of pulsus paradoxus. | The following video depicts and explains the concept of pulsus paradoxus. | ||
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Revision as of 20:50, 9 June 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.
Overview
Physical examination may vary depending on the type of cardiac tamponade. Physical examination may show the classic Beck's triad (hypotension, muffled heart sound, and elevated jugular venous distension), tachycardia, pulsus paradoxus, and pericardial rub depending on the type, and severity of tamponade. Initial diagnosis can be challenging, as there are a number of differential diagnoses, including tension pneumothorax [1], and acute heart failure.
Physical Examination
Appearance of the Patient
- Beck's triad [2]
- Hypotension (due to decreased stroke volume)
- Jugular venous distension (due to impaired venous return to the heart)
- Muffled heart sounds (due to fluid inside the pericardium) [3]
- Distension of veins in the forehead and scalp
- Altered sensorium (decreasing Glasgow coma scale)
- Peripheral edema
Vital Signs
- Sinus tachycardia - common finding on physical examination and seen as an adaptive response of the body towards hypotension.
- Pulsus paradoxus (a drop of > 10 mmHg in arterial blood pressure on inspiration)
- Diminished peripheral pulses
Cardiovascular
Auscultation
In addition to the Beck's triad and pulsus paradoxus the following can be found on cardiovascular examination:
- Pericardial rub
- Clicks - As Ventricular volume shrinks disproportionately, there may be psuedoprolapse/true prolapse of mitral and/or tricuspid valvular structures that result in clicks.
- Kussmaul's sign - Decrease in jugular venous pressure with inspiration is uncommon.
Pulsus Paradoxus
The following video depicts and explains the concept of pulsus paradoxus. {{#ev:youtube|jTsjCZ9QxW8}}
References
- ↑ Gwinnutt, C., Driscoll, P. (Eds) (2003) (2nd Ed.) Trauma Resuscitation: The Team Approach. Oxford: BIOS Scientific Publishers Ltd. ISBN 978-1859960097
- ↑ Gwinnutt, C., Driscoll, P. (Eds) (2003) (2nd Ed.) Trauma Resuscitation: The Team Approach. Oxford: BIOS Scientific Publishers Ltd. ISBN 978-1859960097
- ↑ Dolan, B., Holt, L. (2000). Accident & Emergency: Theory into practice. London: Bailliere Tindall ISBN 978-0702022395