This Article  • Full text  • PDF  • Video  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on ISI (5)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Physical Examination  • Diagnosis  • The Rational Clinical Examination  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic  Social Bookmarking   What's this?

Christopher L. Roy, MD; Melissa A. Minor, MD; M. Alan Brookhart, PhD; Niteesh K. Choudhry, MD, PhD

JAMA. 2007;297:1810-1818.

Context  Cardiac tamponade is a state of hemodynamic compromise resulting from cardiac compression by fluid trapped in the pericardial space. The clinical examination may assist in the decision to perform pericardiocentesis in patients with cardiac tamponade diagnosed by echocardiography.

Objective  To systematically review the accuracy of the history, physical examination, and basic diagnostic tests for the diagnosis of cardiac tamponade.

Data Sources  MEDLINE search of English-language articles published between 1966 and 2006, reference lists of these articles, and reference lists of relevant textbooks.

Study Selection  We included articles that compared aspects of the clinical examination to a reference standard for the diagnosis of cardiac tamponade. We excluded studies with fewer than 15 patients. Of 787 studies identified by our search strategy, 8 were included in our final analysis.

Data Extraction  Two authors independently reviewed articles for study results and quality. A third reviewer resolved disagreements.

Data Synthesis  All studies evaluated patients with known tamponade or those referred for pericardiocentesis with known effusion. Five features occur in the majority of patients with tamponade: dyspnea (sensitivity range, 87%-89%), tachycardia (pooled sensitivity, 77%; 95% confidence interval [CI], 69%-85%), pulsus paradoxus (pooled sensitivity, 82%; 95% CI, 72%-92%), elevated jugular venous pressure (pooled sensitivity, 76%; 95% CI, 62%-90%), and cardiomegaly on chest radiograph (pooled sensitivity, 89%; 95% CI, 73%-100%). Based on 1 study, the presence of pulsus paradoxus greater than 10 mm Hg in a patient with a pericardial effusion increases the likelihood of tamponade (likelihood ratio, 3.3; 95% CI, 1.8-6.3), while a pulsus paradoxus of 10 mm Hg or less greatly lowers the likelihood (likelihood ratio, 0.03; 95% CI, 0.01-0.24).

Conclusions  Among patients with cardiac tamponade, a minority will not have dyspnea, tachycardia, elevated jugular venous pressure, or cardiomegaly on chest radiograph. A pulsus paradoxus greater than 10 mm Hg among patients with a pericardial effusion helps distinguish those with cardiac tamponade from those without. Diagnostic certainty of the presence of tamponade requires additional testing.

Author Affiliations: Divisions of General Medicine and Primary Care (Dr Roy) and Pharmacoepidemiology and Pharmacoeconomics (Drs Brookhart and Choudhry), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Hospitalist Service, Brigham and Women's Hospital, Boston (Drs Roy and Choudhry); and Harvard Vanguard Medical Associates, Boston (Dr Minor).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLE

Pericardial Effusion
John L. Zeller, Cassio Lynm, and Richard M. Glass
JAMA. 2007;297(16):1844.
EXTRACT | FULL TEXT