Physical exam-pericardial tamponade

• Beck’s triad (present in minority of cases): distant heart sounds (28%), ↑ JVP (76%) w/ blunted y descent, hypotension (26%); ± pericardial friction rub (30%)
• Reflex tachycardia (77%), cool extremities
• Pulsus paradoxus (Se 82%, Sp 70%) = ↓ SBP ≥10 mmHg during inspiration ⊕ LR 3.3 (5.9 if pulsus >12), ⊖ LR 0.03 Ddx = PE, hypovolemia, severe COPD, auto-PEEP, periconstriction (~⅓), RV infarct Can be absent if preexisting ↑ LVEDP, arrhythmia, severe AR, ASD, regional tamponade
• Tachypnea and orthopnea but clear lungs