Editing Pericardial effusion/tamponade (section)

== '''Presentation''' ==

* Effusions without tamponade
** Do not cause symptoms in the absence of tamponade, although patients may have pain from pericarditis
** Large effusions - muffled heart sounds, difficult to palpate cardiac impulse
** Friction rub
* Tamponade
** Beck's triad - hypotension, muffled heart sounds and elevated JVP - suggests severe tamponade
** Tachycardia, followed by hypotension, then paradoxical bradycardia at end-stage
** Paradoxical pulse - a drop >10mmHg in systolic BP during inspiration 
*** The difference between the pressure at which Korotkoff sounds first appear, and that at which they are present with every contraction
*** Consider other causes - PE, CP, pulmonary disease with large variations in intra-thoracic pressure
** Something called 'loss of the y descent of the RA or systemic venous pressures' is also characteristic
** Often complain of dyspnoea, which is relieved sitting forward
** Note tamponade can be confused with decompensated heart failure, PE, pulmonary HTN and RV MI - which all can cause hypotension, shock and elevated JVP.