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A 57-year-old female with renal insufficiency has been on dialysis fo
r thirteen years, but has failed to make her last two appointments. She
presents to the emergency room in obvious distress with a blood pressure
of 85/40 and jugular venous distension. Cardiac auscultation reveals no
murmurs, thrills, or heaves. Her heart rate is rapid, at 108 beats/min
, and the peripheral pulses are thready. Pulsus paradoxus is present,
but Kussmaul's sign is absent. Echocardiography reveals the presence
of a small heart. Which of the following is the most likely diagnosis?
A. Cardiac tamponade
B. Constrictive pericarditis
C. Congestive heart failure
D. Myocardial infarct
E. Restrictive cardiomyopathy

[MDiva]

I choose B.

[IMG SURVIVOR]

Kussmaul's sign is absent. What thet means in terms of Dx?

[MDiva]

Its presence could lead to Dx of R. heart failure, cardiac tamponade, and constrictive pericarditis. Since JVD is present and no Kussmaul's sign...does Kussmaul's have to be present for A,B and C?

[GFLIP]

I thought this was a tough question -

I might be really off here, but I'm going to rule out cardiac tamponade, constrictive pericarditis, and restrictive cardiomyopathy because Kussmaul's sign is absent.

Now that leaves me with congestive heart failure and an MI. I would expect a big heart in CHF.

So that leaves me with an MI. My reasoning might suck so feel free to refute my answer.

[MDiva]

Your reasoning seems sound to me, I'll go with MI too.

[vishalforyou]

i think pulsus paradoxus is key here.I dont think in MI there would be pulsus paradoxus present...i will go for cardiac tamponade,coz kussmaul's sign excludes constrictive pericarditis,MI with hypotension is inferior wall MI in which there is vagal stimulation which also causes bradycardia and here there is tachycardia...regarding restrictive cardiomyopathy i dnt have much idea abt physical findings in that conditon...