Case history
Case history #1
A 65-year-old man presents with a 3-day history of decreased exercise tolerance and progressive dyspnea at rest. He does not recall any recent illness, denies recent travel or illicit habits, and takes no medications. Over the past 24 hours he has also noted chest discomfort and bilateral ankle edema. On exam, he is in mild distress, with a jugular venous pressure (JVP) of 13 cm and distant heart sounds. His lungs are clear on auscultation and 1+ pedal edema is noted. He is normotensive with a heart rate of 105 beats per minute (bpm) and a pulsus paradoxus is also evident (>10 mmHg).
Case history #2
A 47-year-old woman presents to her oncologist with decreased exercise tolerance. She was diagnosed with breast cancer 3 years ago and has undergone radical mastectomy, radiation, and chemotherapy. Recently, she has been diagnosed with metastatic disease. On exam, she is tachypneic, has an elevated JVP, and her heart sounds are muffled. She is hypotensive with a blood pressure of 90/50 mmHg. Her heart rate is 110 bpm, and a pulsus paradoxus is present (15 mmHg drop with inspiration).
Other presentations
Cardiac tamponade may have various presenting symptoms ranging from mild dyspnea and atypical chest pain to cardiogenic shock.[2][10] The presence of pulsus paradoxus (>10 mmHg drop in systolic blood pressure with inspiration) is often seen in severe tamponade.[11] Elevated jugular venous pressure is also seen in most cases.
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