Which sign is commonly associated with cardiac tamponade?

Which sign is commonly associated with cardiac tamponade?

• A. Pulsus paradoxus
• B. S3 gallop
• C. Rales
• D. Chest pain with relief on rest

Answer: (A)

In tamponade, fluid around the heart compresses it and restricts filling, especially during inspiration. This commonly produces pulsus paradoxus, an exaggerated drop in systolic blood pressure with inspiration. Normally the systolic BP may vary a little with breathing, but in tamponade the inspiratory increase in venous return to the right heart, constrained by the stiff pericardium, pushes the septum toward the left ventricle and reduces left ventricular preload. That causes a larger-than-normal fall in systolic pressure during inspiration, which you can detect by noting a >10 mmHg drop. The other signs listed reflect different problems: an S3 gallop suggests volume overload in the ventricles, rales indicate fluid in the lungs, and chest pain relieved by rest points to ischemia. None of these are as specifically tied to tamponade as pulsus paradoxus.

In tamponade, fluid around the heart compresses it and restricts filling, especially during inspiration. This commonly produces pulsus paradoxus, an exaggerated drop in systolic blood pressure with inspiration. Normally the systolic BP may vary a little with breathing, but in tamponade the inspiratory increase in venous return to the right heart, constrained by the stiff pericardium, pushes the septum toward the left ventricle and reduces left ventricular preload. That causes a larger-than-normal fall in systolic pressure during inspiration, which you can detect by noting a >10 mmHg drop.

The other signs listed reflect different problems: an S3 gallop suggests volume overload in the ventricles, rales indicate fluid in the lungs, and chest pain relieved by rest points to ischemia. None of these are as specifically tied to tamponade as pulsus paradoxus.