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Evidence summaries

Clinical Diagnosis of Cardiac Tamponade

Most patients with cardiac tamponade may have dyspnoea, tachycardia, elevated jugular venous pressure or cardiomegaly on chest radiograph. Level of evidence: "C"

A systematic review 1 including 8 studies with a total of 300 subjects was abstracted in DARE. Reported sensitivities for the five features shown to occur in the majority of patients with tamponade were as follows: dyspnoea (range: 0.87 to 0.89; 2 studies), tachycardia (0.77, 95% CI: 0.69, 0.85; 4 studies), pulsus paradoxus (0.82, 95% CI: 0.72, 0.92; 7 studies), elevated jugular venous pressure (0.76, 95% CI: 0.62, 0.90; 4 studies) and cardiomegaly on chest radiograph (0.89, 95% CI: 0.73, 1.00; 4 studies). According to 1 study, the presence of pulsus paradoxus greater than 10 mmHg in patients with pericardial effusion increases the likelihood of tamponade (LR 3.3, 95% CI: 1.8, 6.3), whereas 10 mmHg or less lowers the likelihood (LR 0.03, 95% CI: 0.01, 0.24).

Comment: The quality of evidence is downgraded by severe limitations in review methodology.

    References

    • Roy CL, Minor MA, Brookhart MA, Choudhry NK. Does this patient with a pericardial effusion have cardiac tamponade? JAMA 2007 Apr 25;297(16):1810-8. [PubMed][DARE]

Primary/Secondary Keywords