Cardiology MCQ - Make your Diagnosis

A 72 year old female with a history of breast cancer and tobacco use complains of dizziness and dyspnea on exertion. Her heart sounds are distant and her systolic blood pressure is noted to markedly decrease with inspiration. Which of the following is the most likely diagnosis?

A) Constrictive cardiomyopathy

B) Mitral valve Stenosis

C) Congestive heart failure

D) Pulmonary embolus

E) Cardiac Tamponade

Answer    E

                 Cancer is the most common cause of pericardial effusion and when enough fluid accumulates in the pericardial space, cardiac tamponade occurs. “Pulsus paradoxus” is when there is a decrease in systolic blood pressure during inspiration due to failure of the right ventricle to accept the normal increased venous return that occurs with inspiration. This also results in a “Kussmal’s sign” or elevated jugular venous distension during inspiration (normally the opposite occurs). Treatment is with emergent pericardiocentesis.

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