Which cardiovascular findings suggest pericardial effusion?

Updated: Nov 28, 2018
  • Author: William J Strimel, DO, FACP; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Cardiovascular findings in pericardial effusion can include the following:

  • Classic Beck triad of pericardial tamponade - Hypotension, muffled heart sounds, jugular venous distention

  • Pulsus paradoxus - Exaggeration of physiologic respiratory variation in systemic blood pressure, defined as a decrease in systolic blood pressure of more than 10mm Hg with inspiration, signaling falling cardiac output during inspiration

  • Pericardial friction rub

  • Tachycardia

  • Hepatojugular reflux - This can be observed by applying pressure to the periumbilical region; a rise in the jugular venous pressure (JVP) of greater than 3 cm H2 O for more than 30 seconds suggests elevated central venous pressure (however, transient elevation in JVP may be normal)

Pericardial friction rub, the most important physical sign of acute pericarditis, may have up to 3 components per cardiac cycle and is high-pitched, scratching, and grating. It can sometimes be elicited only when firm pressure with the diaphragm of the stethoscope is applied to the chest wall at the left lower sternal border. The pericardial friction rub is heard most frequently during expiration with the patient upright and leaning forward.

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