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. Initial diagnosis can be challenging, as there are a number of differential diagnoses, including tension pneumothorax ^[1], and acute heart failure.

Sinus tachycardia - common finding on physical examination and seen as an adaptive response of the body towards hypotension.
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]
Pulsus paradoxus (a drop of > 10 mmHg in arterial blood pressure on inspiration)
Altered sensorium (decreasing Glasgow coma scale)
Diminished peripheral pulses
Peripheral edema

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.

↑ 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