Physical examination of Cardiac tamponade:
Most physical signs are not specific:
>Systemic arterial hypotension is the rule, but aortic pressure may increase in the early stages of acute tamponade in hypertensive patients due to sympathetic response to pericardial irritation. Patients may also be normotensive, with low pressure tamponade in patients with hypovolaemia or systemic disease.
>Tachycardia may not be present in patients with uraemia or hypothyroidism. Bradycardia due to vasovagal reaction may also be initially seen, especially in iatrogenic tamponade.
>Heart sounds are quiet, but patients with pre-existing cardiomegaly and anterior or apical pericardial adhesions may have active pulsations.
>JVP is usually elevated, with preservation of the x descent but absence of the y descent. However, in acute haemopericardium, there is insufficient time for blood volume to increase, and JVP pulsations may be exaggerated without distension.
>Pulsus paradoxus (>10 mmHg fall in systolic pressure during inspiration) may also be seen with pulmonary embolism, chronic obstructive pulmonary disease, constriction, and rarely in pregnancy. Conditions that can impede the detection of pulsus paradoxus in tamponade are: pericardial adhesions, marked left or right ventricular hypertrophy, severe AR, and ASD.
>Pericardial rub can be heard in inflammatory effusions.
>Kussmaul sign (JVP elevation during inspiration) can be seen but unusually in the absence of pericardial constriction.