Cardiac tamponade

Question 1

Pulsus paradoxus

Answer 1

Greater than the normal (10 mmHg) fall in systolic blood pressure during inspiration → faint or absent pulse in inspiration

Severe asthma, cardiac tamponade

Question 2

Slow rising/plateau pulse

Answer 2

aortic stenosis

Question 3

Collapsing pulse causes

Answer 3

Also know as corrigan’s pulse
o aortic regurgitation
o patent ductus arteriosus
o hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy)

Question 4

Pulsus alternans

Answer 4

o regular alternation of the force of the arterial pulse

o severe LVF

Question 5

Bisferiens pulse

Answer 5

o ‘double pulse’ - two systolic peaks

o mixed aortic valve disease

Question 6

‘Jerky’ pulse

Answer 6

Hypertrophic obstructive cardiomyopathy

Question 7

Cardiac tamponade

Answer 7

Is characterized by the accumulation of pericardial fluid under pressure.

Question 8

Beck’s triad of features for Cardiac tamponade

Answer 8

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hypotension
raised JVP
muffled heart sounds

Question 9

Other features of cardiac tamponade apart from Beck’s triad

Answer 9

1. dyspnoea
2. tachycardia
3. an absent Y descent on the JVP
4. pulsus paradoxus - an abnormally large drop in BP during inspiration
5. Kussmaul’s sign - much debate about this
6. ECG: electrical alternans

Question 10

Pulsus paradoxus

Answer 10

An abnormally large drop in BP during inspiration - found in cardiac tamponade

Question 11

Management of cardiac tamponade

Answer 11

Urgent pericardiocentesis