Cardiac tamponade differential diagnosis: Difference between revisions
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{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh@perfuse.org] | {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh@perfuse.org] | ||
==Overview== | ==Overview== | ||
The initial diagnosis of cardiac tamponade can be challenging, as there are a number of [[differential diagnosis|differential diagnoses]], including [[tension pneumothorax]],<ref name=Gwinnutt/> and acute [[congestive heart failure]]. The differential diagnosis of cardiac tamponade differs based on the type of cardiac tamponade (either acute or subacute). | |||
==Differential | ===Differential Diagnosis of Acute Cardiac Tamponade=== | ||
In a trauma patient presenting with [[PEA]] ([[pulseless electrical activity]]) in the absence of [[hypovolemia]] and [[tension pneumothorax]], the most likely diagnosis is cardiac tamponade.<ref name=ACS>American College of Surgeons Committee on Trauma (2007). ''Advanced Trauma Life Support for Doctors, 7th Edition''. Chicago: American College of Surgeons</ref> | |||
* [[ | *[[Aortic dissection]] | ||
* [[Pulmonary embolus]] | *[[Hypovolemia]] | ||
* [[ | *[[Pulmonary embolus]] | ||
*[[Right ventricular myocardial infarction]] | |||
*[[Tension pneumothorax]] | |||
===Differential | ===Differential Diagnosis of Subacute Cardiac Tamponade=== | ||
* [[Constrictive pericarditis]] | * [[Constrictive pericarditis]] | ||
* [[Congestive heart failure]] | * [[Congestive heart failure]] | ||
* [[Cirrhosis]] | * [[Cirrhosis]] | ||
Signs of classical cardiac tamponade include three signs, known as [[Beck's triad (cardiology)|Beck's triad]]. [[Hypotension]] occurs because of decreased stroke volume, jugular-venous distension due to impaired venous return to the heart, and muffled [[heart sounds]] due to fluid inside the pericardium.<ref name=Dolan>{{cite book |author=Holt L, Dolan B |title=Accident and emergency: theory into practice |publisher=Baillière Tindall |location=London |year=2000 |pages= |isbn=0-7020-2239-X }}</ref> | Signs of classical cardiac tamponade include three signs, known as [[Beck's triad (cardiology)|Beck's triad]]. [[Hypotension]] occurs because of decreased stroke volume, jugular-venous distension due to impaired venous return to the heart, and muffled [[heart sounds]] due to fluid inside the pericardium.<ref name=Dolan>{{cite book |author=Holt L, Dolan B |title=Accident and emergency: theory into practice |publisher=Baillière Tindall |location=London |year=2000 |pages= |isbn=0-7020-2239-X }}</ref> | ||
Revision as of 23:06, 23 September 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.D. [2]
Overview
The initial diagnosis of cardiac tamponade can be challenging, as there are a number of differential diagnoses, including tension pneumothorax,[1] and acute congestive heart failure. The differential diagnosis of cardiac tamponade differs based on the type of cardiac tamponade (either acute or subacute).
Differential Diagnosis of Acute Cardiac Tamponade
In a trauma patient presenting with PEA (pulseless electrical activity) in the absence of hypovolemia and tension pneumothorax, the most likely diagnosis is cardiac tamponade.[2]
- Aortic dissection
- Hypovolemia
- Pulmonary embolus
- Right ventricular myocardial infarction
- Tension pneumothorax
Differential Diagnosis of Subacute Cardiac Tamponade
Signs of classical cardiac tamponade include three signs, known as Beck's triad. Hypotension occurs because of decreased stroke volume, jugular-venous distension due to impaired venous return to the heart, and muffled heart sounds due to fluid inside the pericardium.[3]
Other signs of tamponade include pulsus paradoxus (a drop of at least 10mmHg in arterial blood pressure on inspiration),[4] and ST segment changes on the electrocardiogram,[3] which may also show low voltage QRS complexes,[5] as well as general signs & symptoms of shock (such as tachycardia, breathlessness and decreasing level of consciousness).
Tamponade can often be diagnosed radiographically, if time allows. Echocardiography, which is the diagnostic test of choice**, often demonstrates an enlarged pericardium or collapsed ventricles, and a chest x-ray of a large cardiac tamponade will show a large, globular heart.[5]
References
- ↑ Invalid
<ref>tag; no text was provided for refs namedGwinnutt - ↑ American College of Surgeons Committee on Trauma (2007). Advanced Trauma Life Support for Doctors, 7th Edition. Chicago: American College of Surgeons
- ↑ 3.0 3.1 Holt L, Dolan B (2000). Accident and emergency: theory into practice. London: Baillière Tindall. ISBN 0-7020-2239-X.
- ↑ Invalid
<ref>tag; no text was provided for refs namedMattson - ↑ 5.0 5.1 Invalid
<ref>tag; no text was provided for refs namedLongmore