Cardiac tamponade differential diagnosis
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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
Differential diagnosis differs based on the type of cardiac tamponade (acute or subacute).
Differential diagnosis
Differential diagnosis of acute cardiac tamponade
Differential diagnosis of subacute cardiac tamponade
Initial diagnosis can be challenging, as there are a number of differential diagnoses, including tension pneumothorax,[1] and acute heart failure.[citation needed] 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]
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