cardiac tamponade: how useful are the signs?

11 Sep

Review article by Roy CL, et al.

  • 8 studies, 300 patients total

 

Sensitivity of various signs/symptoms:

  • pulsus paradoxus > 12mmHg 98% (+LR 5.9)
  • pulsus paradoxus > 10mmHg 98% (+LR 3.3)
  • cardiomegaly 89%
  • dyspnea 87-88%
  • tachycardia 77%
  • JVD 76%
  • low voltage on EKG 42%
  • diminished heart sounds 28%
  • hypotension 26%
  • electrical alternans 16-21%

 

BOTTOM LINE:

In terms of using these signs to ‘rule out’ tamponade (or at least put it lower on your differential), some of the classically taught signs/symptoms of tamponade seem to have pretty poor sensitivity.  

Don’t let the absence of certain signs (e.g. decreased heart sounds, electrical alternans), drop tamponade off your differential completely.

 

References: article; picture

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