All of the following are seen in cardiac tamponade except: (Repeat)

Ans: B (Warm periphery) Ref: Harrison's Principles of Internal Medicine, 18th ed.Explanation:Cardiac TamponadeThe accumulation of fluid in the pericardial space in a quantity sufficient to cause serious obstruction to the inflow of blood to the ventricles results in cardiac tamponade.The most common causes of tamponade areNeoplastic diseaseIdiopathic pericarditisRenal failureTuberculosis (Developing countries)Tamponade may also result from bleeding into the pericardial space after cardiac operations, trauma, and treatment of patients with acute pericarditis with anticoagulants.The three principal features of tamponade (Beck's triad) areHypotensionSoft or absent heart soundsjugular venous distention with a prominent x descent but an absent y descent.There are both limitation of ventricular filling and reduction of cardiac output.Tamponade may also develop more slowly, and in these circumstances the clinical manifestations may resemble those of heart failure, including dyspnea, orthopnea, hepatic engorgement and decreased urine output.There may be reduction in amplitude of the QRS complexes, and electrical alternans of the P, QRS, or T waves.Paradoxical Pulse: Greater than normal (> 10 mmHg) inspiratory decline in systolic arterial pressure.DiagnosisWhen pericardial effusion causes tamponade, Doppler ultrasound shows that tricuspid and pulmonic valve flow velocities increase markedly during inspiration, whereas pulmonic vein, mitral, and aortic flow velocities diminish.Often the right ventricular cavity is reduced in diameter, and there is late diastolic inward motion (collapse) of the right ventricular free wall and the right atrium.Transesophageal echocardiography may be necessary to diagnose a Ioculated or hemorrhagic effusion responsible for cardiac tamponade.PericardiocentesisIf manifestations of tamponade appear, echocardiographically or fluoroscopically guided pericardiocentesis must be carried outIntravenous saline may be administered as the patient is being readied for the procedure, but the pericardiocentesis must not be delayed.