Constrictive Pericarditis versus Cardiac Tamponade - USMLE Forums
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Old 06-19-2012
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Heart Constrictive Pericarditis versus Cardiac Tamponade

How do you differentiate between these two?

Both has:
1. Pulsus paradoxus
2. Kussmaul's sign
3. Increased JVP
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Old 06-20-2012
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if q mentions pulsus paradoxus and both are in options, pick CT. simple way...

all i know if PP is more related to CT and kussmaul more with constrictive pericarditis. this helps me.
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Old 06-20-2012
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Default Overall scenario

I would pay close attention to the overall scenario, i would look to things like amyloidosis, sarcoidosis, Rheumatoid arthritis and so on.

eventho both present almost exactly the same way, cardiac tamponade is more acute.

Depends on what the question asks, a CT scan would be a good choice.
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Old 06-20-2012
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Look for calcifications on CXR for constrictive pericarditis and "pericardial KNOCK" on physical exam. Can't think of anything else right now that would diffrentiate these more
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Old 06-20-2012
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Quote:
Originally Posted by tyagee View Post
if q mentions pulsus paradoxus and both are in options, pick CT. simple way...

all i know if PP is more related to CT and kussmaul more with constrictive pericarditis. this helps me.
The question writers knows that......so, it's never going to be that easy.
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Constrictive pericarditis:

1. JVD with rapid descent (prominent diastolic collapse of JVP)--x & y descent.
2. Hepatomegaly and other signs of right heart failure; ascites; fatigue; peripheral edema.
3. Kussmaul's sign (raised JVP on inspiration)
4. Pericardial knock in around 50% cases

Cardiac tamponade:

1. JVD without rapid descent (attenuated diastolic collapse of JVP)
2. Pulsus paradoxus
3. Hypotension
4. Muffled heart sounds
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Old 08-05-2012
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Quote:
Originally Posted by Novobiocin View Post
Constrictive pericarditis:

1. JVD with rapid descent (prominent diastolic collapse of JVP)--x & y descent.
2. Hepatomegaly and other signs of right heart failure; ascites; fatigue; peripheral edema.
3. Kussmaul's sign (raised JVP on inspiration)
4. Pericardial knock in around 50% cases

Cardiac tamponade:

1. JVD without rapid descent (attenuated diastolic collapse of JVP)
2. Pulsus paradoxus
3. Hypotension
4. Muffled heart sounds
for cardiac tamponade, there is increase in heart rate, and equilibration of diastolic pressures in all chambers.
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Old 10-27-2014
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Constrictive pericarditis:

1. JVD WITH rapid descent (prominent diastolic collapse of JVP)--x & y

****Boards know this is classic so USUALLY stay away from it but sometimes it's there so look for it but don't hold your breath

2. Hepatomegaly and other signs of right heart failure; ascites; fatigue; peripheral edema.

3. Kussmaul's sign (raised JVP on inspiration)

4. Pericardial knock in around 50% cases

**5. Pericardial friction rub

**6. Hurts more when laying down OR (even more high yield)--> relieved by leaning forward

**7. Pulsus Paradoxus in approx 33% (UpToDate.com)--MUCH less prevalent than in cardiac tamponade


Cardiac tamponade:

**Beck's Triad: 1, 2 and 3

1. JVD WITHOUT rapid descent (attenuated diastolic collapse of JVP)

2. Muffled heart sounds (aka Distant Heart Sounds. same ****)

3. Hypotension


4. Pulsus paradoxus -- **** Again, boards know this so don't bank on it being there.

**5. Electrical alternans (very specific but VERY low sensitivity): The most frequent cause of electrical alternans is a pericardial effusion; it is thought that the alternating amplitude is the result of a pendulum motion of the heart as it "swings" from beat to beat within the fluid contained in the pericardial sac; there is a change in electrical axis as the heart swings (UpToDate.com).
But of course the boards will never tell you this, nor will they tell you that "the QRS complexes alternate/vary in amplitude from beat to beat...". Instead they either 1) Give you the EKG and expect you to see that pattern yourself (they test your EKG reading abilities as well this way) OR 2) They just tell you that QRS complexes were low in amplitude (which is FAR more sensitive than electrical alternans)

6. Chest x-ray — A chest x-ray showing an enlarged cardiac silhouette with clear lung fields may be seen in slowly developing cardiac tamponade (image 1) [9]. Cardiomegaly is not usually seen in acute cardiac tamponade since at least 200 mL of pericardial fluid must accumulate before the cardiac silhouette enlarges (UpToDate.com)

Last edited by persiano2; 10-27-2014 at 07:39 AM.
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