The Rational Clinical Examination
David L. Simel, Drummond Rennie
Cardiac Tamponade
Christopher L. Roy, Melissa A. Minor, M. Alan Brookhart, Niteesh K. Choudhry
Sections:
Clinical Scenarios, Why Is the Clinical Examination for Cardiac Tamponade Important?, Methods, Results, Scenarios Resolutions, Conclusions, References
Topics Discussed:
cardiac tamponade
Excerpt:
"A 55-year-old woman with chronic obstructive
pulmonary disease presents to your office with 2 weeks of progressive
dyspnea. She had breast cancer diagnosed and treated more than 10
years ago and has had no evidence of recurrence. She was seen in
the emergency department 1 week ago, where her evaluation included
an echocardiogram that demonstrated a moderate-sized (15 mm
in maximum width), circumferential pericardial effusion without
echocardiographic evidence of cardiac tamponade. During your examination,
you note tachycardia and faint heart sounds. A pulsus paradoxus
is 6 mm Hg with a blood pressure of 100/60 mm Hg, the jugular
venous pressure is not elevated, and auscultation of her lungs reveals
diminished breath sounds. You obtain a chest radiograph that is
unchanged from previous films and that shows hyperinflated, clear
lung fields and no enlargement of the cardiac silhouette. You suspect
that the patient's symptoms are attributable to her lung disease,
but should you evaluate further for tamponade?..."
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