Differentials

Constrictive pericarditis

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Seen after radiation therapy or after cardiac surgery or recurrent pericarditis.

Constrictive pericarditis behaves as if there were a box around the heart. Patients have Kussmaul's sign: an increase in jugular venous pressure with inspiration. This is typically absent in tamponade.[4]​​

INVESTIGATIONS

Echocardiogram typically can distinguish between constrictive pericarditis and cardiac tamponade, as constrictive pericarditis typically has a thickened pericardium and no effusion. Early diastolic filling is rapid, with impaired late diastolic filling in constriction. In tamponade, both early and late filling are impaired.[4]​​

CT or MRI may be used to assess the pericardial thickness.

Invasive haemodynamic measurements show a steep y-descent before chamber equalisation that is absent in tamponade, creating a 'dip and plateau' or 'square root sign'.

Pericarditis

Restrictive cardiomyopathy

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Kussmaul's sign (an increase in jugular venous pressure with inspiration).

INVESTIGATIONS

Differentiated from tamponade by absence of effusion. Restriction is also marked by left ventricular hypertrophy, pulmonary hypertension, atrial enlargement, and lack of respiratory reciprocal variation.[4]​​[44]

Assessment of cardiomyopathy

Cardiogenic shock

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Signs and symptoms similar to advanced tamponade.

INVESTIGATIONS

Echocardiogram is useful. Expect poor ventricular function or regions of abnormal wall motion. Effusion is rare. No evidence of chamber collapse or reciprocal variation.

Shock

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