Cardiac tamponade may present with a number of clinical findings, the progression of which depends on how rapidly the pericardial fluid accumulates.


Clinical findings:

(1) chest pain or a feeling of heaviness

(2) syncope

(3) palpitations

(4) dyspnea, especially on exertion

(5) tachypnea

(6) fatigue


Physical findings - classic "triad":

(1) hypotension

(2) tachycardia (pulse > 90 beats per minute, which may be absent in uremia or hypothyroidism)

(3) muffled heart sounds


Additional findings:

(4) pulsus paradoxicus

(5) distended jugular and retinal veins

(6) pericardial rub


If the intrapericardial pressure becomes high enough to seriously impair cardiac output, then signs of low output (cardiogenic) shock develop with:

(1) cold and clammy skin

(2) oliguria

(3) altered mental status

(4) peripheral cyanosis

(5) severe hypotension


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