Differentials
Cardiac tamponade
SIGNS / SYMPTOMS
Absence of facial and upper-extremity edema.
Variation of jugular venous pressure with respiration (prominent x-descent).
Pulsus paradoxus present.
INVESTIGATIONS
Pericardial effusion is seen on CT chest.
Echocardiography shows bouncing septum, marked respiratory variation in the early left ventricular filling velocity (>25%), and right ventricular diastolic collapse.
Constrictive pericarditis
SIGNS / SYMPTOMS
Elevated jugular venous pressure (JVP) with prominent negative descents (x- and y-descent).
Presence of Kussmaul sign (increase in JVP with inspiration).
INVESTIGATIONS
Echocardiography may show thickened pericardium and marked respiratory variation in the early left ventricular filling velocity (>25%).
MRI is the investigation of choice, as it shows pericardial thickening and ventricular interdependence.
Cardiac catheterization shows discordance of left and right ventricular pressures with respiration, which has high specificity for diagnosis.
Acute COPD exacerbation
SIGNS / SYMPTOMS
Extensive bilateral expiratory wheezing, hypoxia, and hypercarbia.
INVESTIGATIONS
Peak flow, spirometry, and bronchodilator response help in differentiating.
Presence of obstructive defect on pulmonary function testing is seen.
Right-sided heart failure
SIGNS / SYMPTOMS
Preserved respiratory variation in jugular venous pressure, prominent negative descents, and sometimes increased v wave due to tricuspid regurgitation.
INVESTIGATIONS
Echocardiography will show right ventricular dysfunction and dilated inferior vena cava with lack of inspiratory collapse.
Pulmonary embolism
SIGNS / SYMPTOMS
Upper-extremity edema is usually absent.
INVESTIGATIONS
CT chest with contrast will show presence of thrombus inside the pulmonary artery.
Cardiac tumor
SIGNS / SYMPTOMS
Upper-extremity edema is usually absent.
INVESTIGATIONS
Echocardiography or cardiac MRI will show presence of a mass, usually inside the right side of the heart.
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