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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Cardiac Tamponade
David L. Simel
Make the Diagnosis: Cardiac Tamponade


Topics Discussed: beck triad, cardiac tamponade, criterion standard comparisons (diagnostic tests), diagnosis, differential, diagnostic process, likelihood ratio, make the diagnosis, pericardial effusion, prior probability, pulsus paradoxus, reference standards

Excerpt: "Cardiac tamponade occurs when fluid trapped in the pericardial space (ie, effusion) compresses the heart and compromises cardiac output. Thus, an assessment of tamponade in the nonurgent setting requires (1) knowing the pretest probability of an effusion and (2) knowing the prior probability of tamponade among patients with effusion. Most studies report only retrospective case series of patients with effusion, so the prior probability of cardiac tamponade is not known. However, because tamponade is so infrequent, among all patients the probability is most likely less than 1%. Among case series of patients with effusion, the prior probability cannot be determined with certainty because of patient selection bias. In a study of patients with effusion who were clinically suspected of having hemodynamic compromise, 64% had tamponade.1 Since many patients with pericardial effusions have small inconsequential amounts of fluid, the likelihood of tamponade in all patients with effusion should be much lower than 64%...."
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