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Cardiac Tamponade: Sensitivity and Specificity

Introduction: Tamponade is an important diagnosis to recognize because of its potential to cause life-threatening hypotension. However, note that hypotension is only present in 24% of patients, at least initially!

[Most of the studies are asking the question: of patients with pericardial effusions, which ones have hemodynamic compromise, i.e. tamponade?]

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Tags: Cardiac Problem Tag this Diagnosis.

The sensitivity and specificity of findings for Cardiac Tamponade are listed below. See the left navigation bar to change the display.

Specific Findings

Finding SensitivitySpecificity Comments, Study
Diminished Heart Sounds Edit 24%100%

Study: Postgraduate Medical Journal 2000;76:809-813

http://pmj.bmj.com/cgi/content/full/76/902/809

Sensitive Findings

Finding SensitivitySpecificity Comments, Study
Pulsus Paradoxus Edit 98%83%

>12 mmHg. Note that pooled results from additional studies only looking at sensitivity showed a decreased sensitivity of around 82%.

The examiner inflates the sphygmomanometer cuff fully, listens for Korotkoff sounds as the cuff is slowly deflated, and then notes the pressure at which Korotkoff sounds are initially audible only during expiration. As the cuff is further deflated, the examiner notes the pressure at which Korotkoff sounds become audible during expiration and inspiration. The difference between these 2 pressures is the pulsus paradoxus. In cardiac tamponade, the pulsus paradoxus measures greater than 10 mm Hg. Inspiratory diminution in the pulse wave amplitude seen on this arterial tracing demonstrates pulsus paradoxus. A similar phenomenon may be observed on a pulse oximeter waveform.

Study: JAMA. 2007;297:1810-1818.

http://jama.ama-assn.org/cgi/content/full/297/16/1810

Elevated JVP Edit 88%83%

>3cm

Study: Postgraduate Medical Journal 2000;76:809-813

http://pmj.bmj.com/cgi/content/full/76/902/809

Tachycardia Edit 88%67%

>100bpm

Study: Postgraduate Medical Journal 2000;76:809-813

http://pmj.bmj.com/cgi/content/full/76/902/809

Dyspnea Edit Sensitivity = 88%

specificity not studied

Study: JAMA. 2007;297:1810-1818.

http://jama.ama-assn.org/cgi/content/full/297/16/1810

Poorly Diagnostic Findings

Finding SensitivitySpecificity Comments, Study
Hypotension Edit 24%83%

SBP < 100mmHg

Study: Postgraduate Medical Journal 2000;76:809-813

http://pmj.bmj.com/cgi/content/full/76/902/809

Fever Edit Sensitivity = 25%

specificity not studied

Study: JAMA. 2007;297:1810-1818.

http://jama.ama-assn.org/cgi/content/full/297/16/1810

Chest Pain Edit Sensitivity = 20%

specificity not studied

Study: JAMA. 2007;297:1810-1818.

http://jama.ama-assn.org/cgi/content/full/297/16/1810

Cough Edit Sensitivity = 10%

specificity not studied

Study: JAMA. 2007;297:1810-1818.

http://jama.ama-assn.org/cgi/content/full/297/16/1810