Cardiac tamponade physical examination

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Differentiating Cardiac Tamponade from other Diseases

Epidemiology and Demographics

Natural History, Complications and Prognosis


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Ahmed Zaghw, M.D. [3]


Physical examination may vary depending on the type of cardiac tamponade. Physical examination may show the classic Beck's triad (hypotension, muffled heart sound, and elevated jugular venous distension), tachycardia, pulsus paradoxus, and pericardial rub depending on the type, and severity of tamponade. Initial diagnosis can be challenging, as there are a number of differential diagnoses, including tension pneumothorax [1], and acute heart failure.

Physical Examination

Appearance of the Patient

The American thoracic surgeon, Beck, has described two clinical triad in 1930. The clinical triads are for both cardiac tamponade and pericardial constriction.

Beck's Triad for Tamponade Beck's Triad Pericardial Constriction
Hypotension (due to decreased stroke volume) Ascites
Jugular venous distension (due to impaired venous return to the heart) High venous pressure
Muffled heart sounds (due to fluid inside the pericardium) [3] Small quiet heart

It should be noted that Beck's triad was descriped for the tamponade casued by acute intrapericardial hemorrhage, eg, traumatic causes of tamponade. This may not apply to other more slowly progressive forms of tamponade associated with a variety of medical conditions as opposed to surgical causes.[4]

Vital Signs



In addition to the Beck's triad and pulsus paradoxus the following can be found on cardiovascular examination:

  • Pericardial rub
  • Clicks - As Ventricular volume shrinks disproportionately, there may be psuedoprolapse/true prolapse of mitral and/or tricuspid valvular structures that result in clicks.
  • Kussmaul's sign - Decrease in jugular venous pressure with inspiration is uncommon.

Pulsus Paradoxus

The following video depicts and explains the concept of pulsus paradoxus.


  1. Gwinnutt, C., Driscoll, P. (Eds) (2003) (2nd Ed.) Trauma Resuscitation: The Team Approach. Oxford: BIOS Scientific Publishers Ltd. ISBN 978-1859960097
  2. Gwinnutt, C., Driscoll, P. (Eds) (2003) (2nd Ed.) Trauma Resuscitation: The Team Approach. Oxford: BIOS Scientific Publishers Ltd. ISBN 978-1859960097
  3. Dolan, B., Holt, L. (2000). Accident & Emergency: Theory into practice. London: Bailliere Tindall ISBN 978-0702022395
  4. Guberman, BA.; Fowler, NO.; Engel, PJ.; Gueron, M.; Allen, JM. (1981). "Cardiac tamponade in medical patients". Circulation. 64 (3): 633–40. PMID 6455217. Unknown parameter |month= ignored (help)