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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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