China
Africa
Explore chapters and articles related to this topic
Practice paper
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
A 33-year-old lady is admitted with severe, sharp central chest pain that is worse when lying down, moving and deep inspiration. She is sat on the edge of the bed and refusing to lie down, as sitting forward relieves the pain slightly. She is given analgesia, becomes more compliant with your examination and you hear a pericardial rub. You request a number of investigations, including an ECG. What is the most likely diagnosis? (1)Give other causes of this condition. (3)What abnormality may be seen on the ECG of a patient with the above diagnosis? (1)Cardiac tamponade is a potential complication of this condition. Beck’s triad may be found on examination of this patient.What is cardiac tamponade? (1)How is cardiac tamponade managed? (1)What is Beck’s triad? (3)
Pericardial disease in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Classical physical findings seen in cardiac tamponade are sinus tachycardia, elevated JVP, muffled heart sounds, systemic hypotension, and pulsus paradoxus. The first three clinical signs together are popularly referred to as Beck’s triad. Some previous studies have suggested that it is not uncommon for patients to have a normal blood pressure or even hypertension during tamponade and this is often due to significantly increased sympathetic activity outweighing the coexistent compressive physiology. Hypertension may be more commonly present in patients who present with subacute rather than acute tamponade (38). Kussmaul’s sign is usually not seen in cardiac tamponade, unless patients have severe coexistent constrictive pericarditis (38).
Answers
Published in Thomas Hester, Iain MacGarrow, Surgical SBAs for Finals with Explanatory Answers, 2018
The symptoms described form part of Beck’s triad of cardiac tamponade: Hypotension due to decreased stroke volume.Jugular venous distension due to impaired venous return to the heart.Muffled heart sounds due to fluid inside the pericardium.
Pericardiocentesis by an Air Medical Service for Cardiac Tamponade Caused by Purulent Pericarditis
Published in Prehospital Emergency Care, 2023
Timothy Boardman, Nicholas North, Sara Sullivan
The frequently taught classic presentation of pericardial tamponade is Beck’s triad, which is the presence of muffled heart sounds, jugular venous distention, and hypotension. However, these findings are only found in 24-34%, 53-88%, and 14-35% of cases respectively (3). Other physical exam and diagnostic findings such as pulses paradoxus and electrical alternans on ECG are also variable and are present in a low percentage of cases (3). Point-of-care ultrasound (POCUS) has been shown to be an effective method of diagnosing pericardial tamponade. Systolic right atrial collapse and diastolic right ventricular collapse have high sensitivity and specificity for pericardial tamponade, and right atrial collapse was clearly identified in this case (3). The use of POCUS in the prehospital setting is becoming more widespread, and recent studies have demonstrated that prehospital clinicians can successfully and accurately perform a wide range of ultrasonographic exams (4). Of note, while the flight crew in this case used the emergency department’s ultrasound machine, our program has since purchased a portable ultrasound machine for use on our helicopter.
Massive purulent pericarditis presenting as cardiac tamponade
Published in Baylor University Medical Center Proceedings, 2020
Azka Latif, Apurva D. Patel, Toufik Mahfood Haddad, Chetan Lokhande, Michael Del Core, Dennis Esterbrooks
Purulent pericarditis is mostly seen in immunocompromised patients. It carries a high mortality and morbidity, with a mortality rate reaching approximately 85% in untreated patients.4 Cardiac tamponade, which is seen in 42% to 77% of patients, can lead to rapid clinical deterioration via septic shock and hemodynamic compromise if left untreated.5,6 Tamponade is usually suspected if the patient has high jugular venous pressure with muffled heart sounds and hypotension (Beck’s triad). A chest radiograph with an enlarged cardiac silhouette is usually seen with large pericardial effusion. However, a rapidly accumulating smaller effusion can lead to tamponade without an enlarging cardiac silhouette, highlighting the importance of echocardiography in acute pericarditis.7