Cardiac tamponade differential diagnosis: Difference between revisions
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===Differential Diagnosis of Acute Cardiac Tamponade=== | ===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> | 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> Other acute disorders that cardiac tamponade must be distinguished from include: | ||
*[[Aortic dissection]] | *[[Aortic dissection]] | ||
*[[Congestive heart failure]] | |||
*[[Hypovolemia]] | *[[Hypovolemia]] | ||
*[[Pulmonary embolus]] | *[[Pulmonary embolus]] | ||
Revision as of 23:09, 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, hypovolemia 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.[1] Other acute disorders that cardiac tamponade must be distinguished from include:
- Aortic dissection
- Congestive heart failure
- 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.[2]
Other signs of tamponade include pulsus paradoxus (a drop of at least 10mmHg in arterial blood pressure on inspiration), and ST segment changes on the electrocardiogram, which may also show low voltage QRS complexes, 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.
References
- ↑ American College of Surgeons Committee on Trauma (2007). Advanced Trauma Life Support for Doctors, 7th Edition. Chicago: American College of Surgeons
- ↑ Holt L, Dolan B (2000). Accident and emergency: theory into practice. London: Baillière Tindall. ISBN 0-7020-2239-X.