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 104/76 mm Hg with a 20 mm Hg decrease in systolic arterial pressure during slow inspiration. Which of the following is the most likely diagnosis?
Correct Answer: cardiac tamponade
Description: The drop in systolic pressure with inspiration is an important clue to cardiac tamponade, called pulsus paradoxus. 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.
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