• Distended neck veins
• Postural hypotension
• Mental status changes
• Kussmaul sign: Distention of neck veins with deep inspiration is pathognomonic of pericardial tamponade
• Paradoxic pulse: A fall of > 10 mm Hg with inspiration supports diagnosis
• Equalization of heart chamber pressures with pulmonary artery catheter placement
• Mechanism of injury often raises suspicion
• Decision must sometimes be made for intervention without full confirmation of diagnosis, eg, thrombectomy or pericardial aspiration for penetrating chest injuries and loss of signs of life
American College of Surgeons: ATLS: Advanced Trauma Life Support Student Manual. American College of Surgeons, 2004.
• Most common cardiac neoplasm is a metastatic lesion (carcinoma of lung or breast, sarcoma, melanoma)
• 75% of primary cardiac neoplasms are benign (myxoma, rhabdomyoma)
• 75% of benign primary cardiac tumors
• Appearance ranges from smooth, round, firm encapsulated mass to loose conglomeration of gelatinous material
• Most attached to fossa ovalis of left atrial septum; some may occur in right atrium or ventricles
• Histologically, contains various mesenchymal cells
• Papillary fronds attached to aortic valve associated with cerebral and coronary embolization
• Fibromas occur in pediatric patients, slowly invading conduction system
• Presentation depends on type and location of tumor
• Malignant tumors: Rapidly progressive congestive heart failure from valvular or myocardial infiltration
• Myxoma: Fever, weight loss, anemia, systemic embolization
• Mitral stenosis can occur from tumor causing characteristic early diastolic sound "tumor plop"
• Fibromas can cause sudden death from arrhythmias
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