A 34-year-old man presents with dyspnea and increasing peripheral edema. He recently had a "flu like" illness with intermittent sharp left-sided chest pain. On examination, his jugular venous pressure (JVP) is elevated at 8 cm, heart sounds are soft and the blood pressure (BP) is 125/80 mm Hg with a 20 mm Hg decrease in systolic arterial pressure during slow inspiration. Which of the following is the most likely diagnosis?
The drop in systolic pressure with inspiration is an important clue to cardiac tamponade, called paradoxical pulse. When severe, the arterial pulse may weaken on palpation during inspiration. Pulsus paradoxus is uncommon in constrictive pericarditis and rare in restrictive cardiomyopathy. It is commonly found in severe asthma as well.
cardiac tamponade
pulmonary hypertension
ventricular septal defect
coarctation of the aorta
C.V.S.