Cardiac tamponade physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-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.
Physical Examination
Initial diagnosis can be challenging, as there are a number of differential diagnoses, including Tension pneumothorax [1], and acute heart failure.
Classical cardiac tamponade presents three signs, known as Beck's triad[2]. 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] Another sign of tamponade on physical examination includes pulsus paradoxus (a drop of at least 10 mmHg in arterial blood pressure on inspiration) [4]. There may also be general signs & symptoms of cardiogenic shock (such as tachycardia, breathlessness, poor perfusion of the extremities and decreasing level of consciousness). Peripheral edema may be present. Hemodynamic changes diminish S1 and S2 . As Ventricular volume shrinks disproportionately, there may be psuedoprolapse/true prolapse of mitral and/or tricuspid valvular structures that result in clicks.
Pulsus paradoxsus
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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
- ↑ Mattson Porth, C. (Ed.) (2005) (7th Ed.) Pathophysiology: Concepts of Altered Health States. Philadelphia : Lippincott Williams & Wilkins ISBN 978-0781749886