58 - cardiac tamponade

Q- all of the following features may be seen in cardiac tamponade ,except

a- kussmaul's sign
b- pulsus paradoxus
c- electric alterans
d- right ventricular diastolic collapse on echo

answer is a . kussmaul's sign is seen in constrictive pericarditis , where as it is very rare in cardiac tamponade .

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Q- all of the following features are seen in cardiac tamponade , except

a- raised JVP
b- kussmaul's sign
c- rapid y descent
d- pulsus paradoxus

answer is c .

this is a tricky question . rapid y descent is a feature of constrictive pericarditis and not the cardiac tamponade . as i have already told u , kussmaul's sign is rare in cardiac tamponade , nonetheless present and so the answer is c.

cardiac tamponade is characterised by AN ABSENT OR DIMUNITIVE Y DESCENT AND A PROMINENT X DESCENT .

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solve the following case

Q- A patient presents with engorged neck veins ,BP 80/50 and pulse rate of 100 following blunt trauma to the chest ,the diagnosis is?

a- pneumothorax
b- right ventricular failure
c- cardiac tamponade
d- hemothorax

answer is c .

the characteristic triad of the cardiac tamponade is

1- raised JVP

2- rising venous pressure and falling arterial pressure

3- distant heart sounds ( quiet heart )

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when the question says something about prominent both x and y descent on JVP, the answer is constrictive pericarditis . but if the question says there is a prominent X descent and absent or dimunitive Y descent , then the diagnosis is cardiac tamponade .

the points that support the cardiac tamponade are - PULSUS PARADOXICUS , ELECTRICAL ALTERANS AND ABSENT OR DIMUNITIVE Y DESCENT .

the points that favour constrictive pericarditis are - PROMINENT Y DESCENT , KUSSMAUL'S SIGN AND PERICARDIAL KNOCK ( rare in cardiac tamponade )