Dr. Cate Edgell presented an interesting case of a patient with acute onset chest pain and dyspnea on exertion. Exam was notable for hypotension, muffled heart sounds, elevated JVP (Beck’s triad) and disappearance of palpated peripheral pulse with inspiration (suggestive of severe pulsus paradoxes), concerning for tamponade physiology. This was confirmed by echocardiogram. Patient underwent emergent pericardiocentesis with drain placement with subsequent improvement in clinic status.
Tamponade is a clinical diagnosis. Consider this in patients presenting with shock with elevated JVP and positive pulsus paradoxes.
Weakening or disappearance of peripheral pulse with inspiration is suggestive of positive pulsus (systolic blood pressure decline of more than 10 mmHg during inspiration)
If you are concerned for tamponade, CALL Cards and ACTIVATE the cath lab!