330:
438:(tPA) or catheter-directed. tPA works to break up the clot. A major risk of tPA is bleeding. Thus, patients must be assessed for their risk of bleeding and contraindications. Catheter-directed therapy involves giving tPA locally in the pulmonary artery. It can also fragment and remove the clot itself (embolectomy). This local therapy has a lower risk of bleeding. Surgical embolectomy is a more invasive treatment, associated with 10-20% surgical mortality risk.
284:
227:
383:
assess for causes of obstructive shock. The vena cava would be dilated due to the obstruction. In pulmonary embolism, the right ventricle will be dilated. Other findings include paradoxical septal motion or clots in the right heart or pulmonary artery. Echocardiography can assess for pericardial effusion. In tamponade, collapse of the right atrium and ventricle would be seen due to pressure in the pericardial sac.
271:
tension pneumothorax. This is life-threatening. The increased pressure inside the chest can compress the heart and lead to a collapse of the blood vessels that drain to the heart. The veins supplying the heart are compressed, in turn decreasing venous return. With the heart unable to fill, cardiac output drops. Hypotension and shock ensue. If not rapidly treated, it can lead to
407:. In some cases, fluids may be beneficial. Fluids can improve venous return. For example, tamponade prevents normal cardiac filling due to pressure compressing the heart. In this case, giving fluids can improve right heart filling. However, in other causes of obstructive shock, too much fluid can worsen cardiac output. Thus, fluid therapy should be monitored closely.
361:
Rapid evaluation of shock is essential given its life-threatening nature. Diagnosis requires a thorough history, physical exam, and additional tests. One must also consider the possibility of multiple types of shock being present. For example, a trauma patient may be hypovolemic from blood loss. This
341:
is fluid in the pericardial sac. When large enough, the pressure compresses the heart. This causes shock by preventing the heart from filling with blood. This is called cardiac tamponade. The chambers of the heart can collapse from this pressure. The right heart has thinner walls and collapses more
382:
should be used. This is non-invasive and can help diagnose the four types of shock. Echocardiography can look for ventricular dysfunction, effusions, or valve dysfunction. Measurement of the vena cava during the breathing cycle can help assess volume status. A point-of-care echocardiogram can also
374:
rises due to poor tissue perfusion. This may even be an initial sign of shock and rise before blood pressure decreases. Lactic acid should lower with appropriate treatment of shock. EKG should also be performed. Tachycardia is often present, but other specific findings may be present based on the
270:
around the lungs. Normally, this space has negative pressure to allow the lung to fill. Pressure increases as more air enters this space. The lung collapses, impairing normal breathing. Surrounding structures may also shift. When severe enough to cause these shifts and hypotension, it is called a
410:
After these stabilizing measures, further treatment depends on the cause. Treatment of the underlying condition can quickly resolve the shock. For tension pneumothorax, needle decompression should be done immediately. A chest tube is also inserted. Cardiac tamponade is treated through needle or
386:
A chest X-ray can rapidly identify a pneumothorax, seen as absence of lung markings. Ultrasound can show the lack of lung sliding. However, imaging should not delay treatment. CT angiography is the standard of diagnosis of pulmonary embolism. Clots appear in the vasculature as filling defects.
162:
Other signs may be seen depending on the underlying cause. For example, jugular venous distension is a significant finding in evaluating shock. This occurs in cardiogenic and obstructive shock. This is not observed in the other two types of shock, hypovolemic and distributive. Some particular
1631:"European Society of C 2015 ESC guidelines for the diagnosis and management of pericardial diseases: the task force for the diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) endorsed by: the European Association for CardioThoracic Surgery (EACTS)"
365:
Vital signs in obstructive shock may show hypotension, tachycardia, and/or hypoxia. A physical exam include be thorough, including jugular vein exam, cardiac and lung exams, and assessing skin tone and temperature. Response to fluids may aid in diagnosis. Labs including a
395:
In any type of shock, rapid treatment is essential. Delays in therapy increase the risk of mortality. This is often done as diagnostic assessment is still occurring. Resuscitation addresses the ABC's - airway, breathing, and circulation. Supplemental oxygen is given, and
193:
Tension pneumothorax would have decreased breath sounds on the affected side. Tracheal deviation may also be present, shifted away from the affected side. Thus, a lung exam is important. Other findings may include decreased chest mobility and air underneath the skin
138:
However, it is important to distinguish between the two types, because treatment is different. In cardiogenic shock, the problem is in the function of the heart itself. In obstructive shock, the underlying problem is not the pump. Rather, the input into the heart
147:) is higher than normal. Treating the underlying cause can reverse the shock. For example, tension pneumothorax needs rapid needle decompression. This decreases the pressure in the chest. Blood flow to and from the heart is restored, and shock resolves.
295:. Deaths from PE have been estimated at ~100,000 per year in the United States. However, this may be higher in recent years. Most often, the obstruction is a blood clot that traveled from elsewhere in the body. Most commonly, this is from a
201:
Pulmonary embolism similarly presents with shortness of breath and hypoxia. Chest pain worse with inspiration is frequently seen. Chest pain can also be similar to a heart attack. This is due to the right ventricular stress and
159:, and hypoxia may be present. Because of poor blood flow to the tissues, patients may have cold extremities. Less blood to the kidneys and brain can cause decreased urine output and altered mental status, respectively.
314:. If large enough, the clot increases the load on the right side of the heart. The right ventricle must work harder to pump blood to the lungs. With back-up of blood, the right ventricle can begin to dilate.
2931:
242:
Causes include any obstruction of blood flow to and from the heart. There are multiple, including pulmonary embolism, cardiac tamponade, and tension pneumothorax. Other causes include
214:. DVT is a common cause. Thus, symptoms including leg pain, redness, and swelling can be present. The likelihood of pulmonary embolism can be evaluated through various criteria. The
155:
As in all types of shock, low blood pressure is a key finding in patients with obstructive shock. In response to low blood pressure, heart rate increases. Shortness of breath,
131:
can be observed in the neck. This finding can be seen in obstructive and cardiogenic shock. With the decrease cardiac output, blood flow to vital tissues is decreased. Poor
2517:
333:
Echocardiogram of cardiac tamponade. Fluid surrounding the heart impairs proper filling. This swinging of the heart causes electrical alternans seen on EKG.
984:"2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)"
1108:
Sista AK, Kuo WT, Schiebler M, Madoff DC (July 2017). "Stratification, Imaging, and
Management of Acute Massive and Submassive Pulmonary Embolism".
674:
Funk DJ, Jacobsohn E, Kumar A (February 2013). "Role of the venous return in critical illness and shock: part II-shock and mechanical ventilation".
345:
Whether an effusion causes tamponade depends on the amount of fluid and how long it took to accumulate. When fluid collects slowly, the
2158:
321:
A PE is considered "massive" when it causes hypotension or shock. A submassive PE causes right heart dysfunction without hypotension.
760:
Massaro AF (2018). "Approach to the
Patient with Shock.". In Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J (eds.).
1848:
135:
to organs leads to shock. Due to these similarities, some sources place obstructive shock under the category of cardiogenic shock.
2575:
1892:
490:
1698:
769:
599:
538:
473:
2379:
2216:
2570:
2384:
2374:
1963:
2681:
2512:
2126:
230:
Left-sided tension pneumothorax. Note the area without lung markings which is air in the pleural space. Also note the
2552:
47:; pulmonary embolism; abdominal compartment syndrome; severe aortic stenosis; constrictive pericarditis; SVC syndrome
299:(DVT) in the legs or pelvis. Risk factors are conditions that increase the risk of clotting. This includes genetic (
2547:
464:
Doerschug KC, Schmidt GA (2016). "Shock: Diagnosis and
Management.". In Oropello JM, Pastores SM, Kvetan V (eds.).
342:
easily. With less venous return, cardiac output decreases. The lack of blood flow to vital organs can cause death.
2416:
2197:
2492:
2487:
2411:
1756:
243:
109:
2838:
2714:
2643:
2475:
2211:
400:
is performed if indicated. Intravenous fluids can increase blood pressure and maintain blood flow to organs.
367:
311:
258:. Constrictive pericarditis is a rare cause. Masses can grow to press on major blood vessels causing shock.
2833:
2626:
2609:
2542:
2462:
1841:
498:
167:
2676:
2121:
2658:
2146:
2131:
1381:
Chiabrando JG, Bonaventura A, Vecchié A, Wohlford GF, Mauro AG, Jordan JH, et al. (January 2020).
1154:"Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review"
982:
Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. (January 2020).
2205:
2736:
2433:
2401:
2328:
2055:
1691:
965:
2860:
2686:
2616:
2406:
2303:
2284:
2114:
1887:
1629:
Adler Y, Charron P, Imazio M, Badano L, Baron-Esquivias G, Bogaert J, et al. (November 2015).
353:. Acute effusions can cause tamponade when small because the tissue does not have time to stretch.
88:, caused by a physical obstruction in the flow of blood. Obstruction can occur at the level of the
44:
872:
Roberts DJ, Leigh-Smith S, Faris PD, Blackmore C, Ball CG, Robertson HL, et al. (June 2015).
482:
2893:
2867:
2855:
2843:
2828:
2562:
2504:
2308:
2289:
1941:
1881:
1834:
419:
may be placed for continued drainage. If these methods are not effective, surgery may be needed.
215:
128:
2482:
2448:
2391:
2369:
2191:
2173:
2109:
1976:
1929:
1857:
195:
62:
303:) and acquired conditions (cancer). Trauma, surgery, and prolonged bed-rest are common risks.
2246:
2241:
2136:
2051:
1946:
983:
2742:
2270:
2251:
2151:
2062:
2005:
1738:
1684:
1206:
Kearns MJ, Walley KR (May 2018). "Tamponade: Hemodynamic and
Echocardiographic Diagnosis".
338:
296:
183:
8:
2747:
2604:
2599:
2522:
2426:
2396:
2355:
1981:
1898:
1707:
397:
187:
140:
127:) is decreased. This causes a back-up of blood into the veins entering the right atrium.
108:. These are all life-threatening. Symptoms may include shortness of breath, weakness, or
85:
2850:
2648:
2470:
2421:
2046:
1993:
1903:
1815:
1733:
1715:
1657:
1630:
1606:
1579:
1560:
1512:
1487:
1463:
1436:
1412:
1363:
1296:
1269:
1231:
1180:
1153:
1085:
1060:
953:
903:
854:
841:
699:
644:
619:
420:
412:
218:
is often calculated. It gives points based on these symptoms and patient risk factors.
207:
171:
97:
1152:
Sakr Y, Giovini M, Leone M, Pizzilli G, Kortgen A, Bauer M, et al. (2020-09-16).
1061:"Time Trends in Pulmonary Embolism Mortality Rates in the United States, 1999 to 2018"
329:
2761:
2719:
2634:
2452:
2350:
2067:
2010:
1908:
1800:
1662:
1611:
1564:
1552:
1517:
1468:
1416:
1404:
1355:
1301:
1223:
1185:
1125:
1090:
1059:
Martin KA, Molsberry R, Cuttica MJ, Desai KR, Schimmel DR, Khan SS (September 2020).
1035:
1008:
935:
895:
858:
846:
799:
765:
733:
691:
649:
595:
566:
534:
469:
170:. The triad includes hypotension, jugular vein distension, and muffled heart sounds.
120:
101:
52:
30:
1235:
824:
703:
618:
Standl T, Annecke T, Cascorbi I, Heller AR, Sabashnikov A, Teske W (November 2018).
403:
However, fluids should be given with caution. Too much fluid can cause overload and
2883:
2775:
2668:
2364:
1728:
1652:
1642:
1601:
1591:
1544:
1507:
1499:
1458:
1448:
1394:
1367:
1345:
1291:
1281:
1215:
1175:
1165:
1117:
1080:
1072:
998:
907:
885:
836:
683:
639:
631:
379:
292:
175:
874:"Clinical Presentation of Patients With Tension Pneumothorax: A Systematic Review"
2905:
2297:
2278:
2265:
2072:
1951:
1826:
1548:
890:
873:
687:
404:
371:
300:
251:
1267:
1219:
287:"Saddle" embolism on CT. The filling defect in the pulmonary artery is the clot.
2898:
2806:
2704:
2696:
2594:
2104:
2097:
2084:
1647:
1399:
1382:
1250:
1170:
1027:
1003:
929:
791:
725:
558:
272:
267:
124:
1453:
1383:"Management of Acute and Recurrent Pericarditis: JACC State-of-the-Art Review"
1121:
635:
2925:
2888:
2799:
1934:
1810:
1782:
1268:
PĂ©rez-Casares A, Cesar S, Brunet-Garcia L, Sanchez-de-Toledo J (2017-04-24).
850:
315:
247:
190:. However, EKG may not show these findings and most often shows tachycardia.
89:
1503:
1286:
1270:"Echocardiographic Evaluation of Pericardial Effusion and Cardiac Tamponade"
1076:
57:
Thorough history and physical exam; EKG; echocardiogram; X-ray; CT angiogram
2820:
2794:
2638:
2586:
2259:
2235:
2182:
2041:
1805:
1723:
1666:
1615:
1556:
1521:
1472:
1408:
1359:
1305:
1227:
1189:
1129:
1094:
1039:
1012:
939:
899:
803:
737:
695:
653:
570:
427:
105:
1596:
1350:
1333:
2755:
2653:
2443:
2360:
2342:
2168:
2141:
2092:
2033:
1777:
431:
362:
patient could also have tension pneumothorax due to trauma to the chest.
346:
235:
179:
113:
116:
are often seen in shock. Other symptoms depend on the underlying cause.
2783:
2333:
1772:
1535:
Marik PE, Weinmann M (June 2019). "Optimizing fluid therapy in shock".
211:
435:
283:
156:
144:
132:
1380:
529:
Walley KR (2014). "Shock". In Hall JB, Schmidt GA, Kress JP (eds.).
2709:
1866:
416:
415:
can be done at the bedside. This is often the preferred therapy. A
304:
226:
203:
143:) is decreased or the pressure against which the heart is pumping (
1488:"Pericardial disease: what the general cardiologist needs to know"
981:
231:
1577:
871:
620:"The Nomenclature, Definition and Distinction of Types of Shock"
2789:
2769:
1924:
2932:
Pulmonary heart disease and diseases of pulmonary circulation
350:
255:
93:
1058:
617:
590:
Cotran RS, Kumar V, Fausto N, Robbins SL, Abbas AK (2005).
349:
can stretch. Thus, a chronic effusion can be as large as 1
1025:
1676:
1628:
1578:
Sagristà -Sauleda J, Mercé AS, Soler-Soler J (May 2011).
1151:
589:
67:
Cardiogenic shock; hypovolemic shock; distributive shock
1107:
370:
can assess electrolytes and kidney and liver function.
977:
975:
423:
is a surgery that is particularly in cases of cancer.
972:
291:A pulmonary embolism (PE) is an obstruction of the
16:
Insufficient blood flow due to physical obstruction
1856:
1580:"Diagnosis and management of pericardial effusion"
673:
552:
550:
119:The physiology of obstructive shock is similar to
594:. St. Louis, Mo: Elsevier Saunders. p. 141.
583:
2923:
1331:
463:
459:
457:
455:
453:
451:
1327:
1325:
1323:
1321:
1319:
1317:
1315:
1248:
1034:. Treasure Island (FL): StatPearls Publishing.
1026:Waheed SM, Kudaravalli P, Hotwagner DT (2021).
934:. Treasure Island (FL): StatPearls Publishing.
798:. Treasure Island (FL): StatPearls Publishing.
785:
783:
781:
732:. Treasure Island (FL): StatPearls Publishing.
565:. Treasure Island (FL): StatPearls Publishing.
556:
547:
266:A pneumothorax occurs when air collects in the
1430:
1428:
1426:
1251:"Metastatic involvement of cardiac structures"
1201:
1199:
755:
753:
592:Robbins and Cotran pathologic basis of disease
123:. In both types, the heart's output of blood (
1842:
1692:
1534:
1485:
1387:Journal of the American College of Cardiology
719:
717:
715:
713:
613:
611:
524:
522:
520:
518:
516:
514:
512:
510:
508:
448:
1312:
1205:
1147:
1145:
1143:
1141:
1139:
923:
921:
919:
917:
778:
1423:
1196:
789:
750:
723:
669:
667:
665:
663:
2159:Arrhythmogenic right ventricular dysplasia
1849:
1835:
1699:
1685:
1486:Ivens EL, Munt BI, Moss RR (August 2007).
1101:
762:Harrison's Principles of Internal Medicine
710:
608:
505:
166:A classic finding of cardiac tamponade is
1656:
1646:
1605:
1595:
1511:
1462:
1452:
1398:
1349:
1295:
1285:
1242:
1179:
1169:
1136:
1084:
1065:Journal of the American Heart Association
1002:
927:
914:
889:
840:
825:"Under pressure: Acute cardiac tamponade"
643:
206:that can occur in PE. Other symptoms are
43:Tension pneumothorax; cardiac tamponade;
1332:Vincent JL, De Backer D (October 2013).
660:
328:
282:
225:
759:
318:can ensue, leading to shock and death.
261:
238:shift from the patient's left to right.
163:clinical findings are described below.
75:Depends on the cause of the obstruction
2924:
1893:Spontaneous coronary artery dissection
1437:"Echocardiography in shock management"
1434:
528:
491:"Shock: Shock and Fluid Resuscitation"
434:. Thrombolysis can be systemic via IV
1830:
1680:
1249:Ewer MS, Benjamin RS, Yeh ET (2003).
278:
150:
2217:Nonbacterial thrombotic endocarditis
822:
488:
426:Massive pulmonary embolism requires
324:
13:
2513:Accelerated idioventricular rhythm
842:10.1097/01.CCN.0000553086.79399.f0
624:Deutsches Ă„rzteblatt International
14:
2943:
1537:Current Opinion in Critical Care
2198:Subacute bacterial endocarditis
1622:
1571:
1528:
1479:
1374:
1338:New England Journal of Medicine
1261:
1052:
1019:
865:
816:
411:surgical decompression. Needle
310:This obstruction increases the
1757:Abdominal compartment syndrome
764:(20th ed.). McGraw Hill.
557:Haseer Koya M, Paul M (2021).
380:point-of-care echocardiography
244:abdominal compartment syndrome
178:may also be seen. Low-voltage
1:
2715:Pulseless electrical activity
2644:Multifocal atrial tachycardia
2518:Catecholaminergic polymorphic
533:(4th ed.). McGraw Hill.
441:
312:pulmonary vascular resistance
1549:10.1097/MCC.0000000000000604
1255:Holland-Frei Cancer Medicine
891:10.1097/SLA.0000000000001073
688:10.1097/CCM.0b013e31827bfc25
390:
356:
84:is one of the four types of
7:
1584:World Journal of Cardiology
1220:10.1016/j.chest.2017.11.003
790:Stashko E, Meer JM (2021).
531:Principles of Critical Care
10:
2948:
2659:Wandering atrial pacemaker
2206:non-infective endocarditis
2147:Endocardial fibroelastosis
1400:10.1016/j.jacc.2019.11.021
1257:(6th ed.). BC Decker.
1171:10.1186/s13613-020-00741-0
724:Jalota R, Sayad E (2021).
2876:
2819:
2737:hexaxial reference system
2728:
2695:
2682:Jervell and Lange-Nielsen
2667:
2625:
2584:
2561:
2535:
2503:
2461:
2442:
2341:
2327:
2227:
2212:Libman–Sacks endocarditis
2181:
2167:
2083:
2032:
2025:
1962:
1917:
1874:
1865:
1793:
1765:
1747:
1714:
1706:
1454:10.1186/s13054-016-1401-7
1435:McLean AS (August 2016).
1122:10.1148/radiol.2017151978
636:10.3238/arztebl.2018.0757
495:Merck Manual Professional
307:is a recent risk factor.
221:
129:Jugular venous distension
112:. Low blood pressure and
71:
61:
51:
39:
29:
24:
2617:Ventricular fibrillation
1888:Coronary artery aneurysm
1648:10.1093/eurheartj/ehv318
1158:Annals of Intensive Care
1004:10.1093/eurheartj/ehz405
931:Acute Pulmonary Embolism
928:Vyas V, Goyal A (2021).
2894:Diastolic heart failure
2868:Athletic heart syndrome
2829:Ventricular hypertrophy
2563:Pre-excitation syndrome
2417:Left posterior fascicle
1942:Acute coronary syndrome
1882:Coronary artery disease
1504:10.1136/hrt.2005.086587
1287:10.3389/fped.2017.00079
1274:Frontiers in Pediatrics
1077:10.1161/JAHA.120.016784
254:, and disorders of the
96:itself. Causes include
2412:Left anterior fascicle
2192:infective endocarditis
1977:Hibernating myocardium
1858:Cardiovascular disease
1635:European Heart Journal
1028:"Deep Vein Thrombosis"
991:European Heart Journal
726:"Tension Pneumothorax"
676:Critical Care Medicine
334:
288:
239:
196:subcutaneous emphysema
63:Differential diagnosis
2576:Wolff–Parkinson–White
2536:Premature contraction
2434:Adams–Stokes syndrome
2137:Loeffler endocarditis
1947:Myocardial infarction
1597:10.4330/wjc.v3.i5.135
1351:10.1056/nejmra1208943
829:Nursing Critical Care
332:
286:
252:aortic valve stenosis
229:
110:altered mental status
2743:Right axis deviation
2705:Sudden cardiac death
2063:Pericardial effusion
2006:Ventricular aneurysm
1739:Toxic shock syndrome
823:Chen LL (May 2019).
501:on 12 February 2010.
489:Weil MH (May 2007).
339:pericardial effusion
297:deep vein thrombosis
262:Tension pneumothorax
184:electrical alternans
106:tension pneumothorax
45:Budd chiari syndrome
2748:Left axis deviation
2605:Atrial fibrillation
2600:Ventricular flutter
2523:Torsades de pointes
2397:Bundle branch block
2356:Sick sinus syndrome
2142:Cardiac amyloidosis
2127:Tachycardia-induced
1982:Myocardial stunning
1930:Prinzmetal's angina
1899:Coronary thrombosis
1334:"Circulatory shock"
792:"Cardiac Tamponade"
316:Right heart failure
2851:Atrial enlargement
2649:Pacemaker syndrome
2571:Lown–Ganong–Levine
2493:Junctional ectopic
2488:AV nodal reentrant
1994:Myocardial rupture
1904:Coronary vasospasm
1816:Vasodilatory shock
1734:Anaphylactic shock
421:Pericardial window
413:pericardiocentesis
375:underlying cause.
335:
293:pulmonary arteries
289:
279:Pulmonary embolism
240:
151:Signs and Symptoms
98:pulmonary embolism
2919:
2918:
2911:Obstructive shock
2815:
2814:
2762:Short QT syndrome
2729:Other / ungrouped
2720:Sinoatrial arrest
2635:Ectopic pacemaker
2531:
2530:
2351:Sinus bradycardia
2323:
2322:
2319:
2318:
2068:Cardiac tamponade
2021:
2020:
2011:Dressler syndrome
1909:Myocardial bridge
1824:
1823:
878:Annals of Surgery
771:978-1-259-64401-6
601:978-0-7216-0187-8
540:978-0-07-173881-1
475:978-0-07-182081-3
325:Cardiac tamponade
121:cardiogenic shock
102:cardiac tamponade
82:Obstructive shock
79:
78:
53:Diagnostic method
25:Obstructive Shock
19:Medical condition
2939:
2884:Cardiac fibrosis
2776:T wave alternans
2669:Long QT syndrome
2463:Supraventricular
2459:
2458:
2392:Intraventricular
2339:
2338:
2179:
2178:
2030:
2029:
1875:Coronary disease
1872:
1871:
1851:
1844:
1837:
1828:
1827:
1729:Neurogenic shock
1701:
1694:
1687:
1678:
1677:
1671:
1670:
1660:
1650:
1626:
1620:
1619:
1609:
1599:
1575:
1569:
1568:
1532:
1526:
1525:
1515:
1483:
1477:
1476:
1466:
1456:
1432:
1421:
1420:
1402:
1378:
1372:
1371:
1353:
1329:
1310:
1309:
1299:
1289:
1265:
1259:
1258:
1246:
1240:
1239:
1214:(5): 1266–1275.
1203:
1194:
1193:
1183:
1173:
1149:
1134:
1133:
1105:
1099:
1098:
1088:
1056:
1050:
1049:
1047:
1046:
1023:
1017:
1016:
1006:
988:
979:
970:
969:
963:
959:
957:
949:
947:
946:
925:
912:
911:
893:
884:(6): 1068–1078.
869:
863:
862:
844:
820:
814:
813:
811:
810:
787:
776:
775:
757:
748:
747:
745:
744:
721:
708:
707:
671:
658:
657:
647:
615:
606:
605:
587:
581:
580:
578:
577:
554:
545:
544:
526:
503:
502:
497:. Archived from
486:
480:
479:
461:
378:At the bedside,
176:pulsus paradoxus
22:
21:
2947:
2946:
2942:
2941:
2940:
2938:
2937:
2936:
2922:
2921:
2920:
2915:
2906:Rheumatic fever
2872:
2811:
2724:
2691:
2663:
2621:
2580:
2557:
2527:
2499:
2446:
2438:
2332:
2315:
2223:
2172:
2163:
2079:
2073:Hemopericardium
2017:
1958:
1952:Unstable angina
1925:Angina pectoris
1918:Active ischemia
1913:
1861:
1855:
1825:
1820:
1789:
1761:
1743:
1710:
1705:
1675:
1674:
1641:(42): 2921–64.
1627:
1623:
1576:
1572:
1533:
1529:
1498:(8): 993–1000.
1484:
1480:
1433:
1424:
1379:
1375:
1344:(18): 1726–34.
1330:
1313:
1266:
1262:
1247:
1243:
1204:
1197:
1150:
1137:
1106:
1102:
1071:(17): e016784.
1057:
1053:
1044:
1042:
1024:
1020:
986:
980:
973:
961:
960:
951:
950:
944:
942:
926:
915:
870:
866:
821:
817:
808:
806:
788:
779:
772:
758:
751:
742:
740:
722:
711:
672:
661:
630:(45): 757–768.
616:
609:
602:
588:
584:
575:
573:
555:
548:
541:
527:
506:
487:
483:
476:
468:. McGraw Hill.
462:
449:
444:
405:pulmonary edema
393:
368:metabolic panel
359:
327:
301:factor V Leiden
281:
264:
224:
172:Kussmaul's sign
153:
20:
17:
12:
11:
5:
2945:
2935:
2934:
2917:
2916:
2914:
2913:
2908:
2903:
2902:
2901:
2899:Cardiac asthma
2896:
2886:
2880:
2878:
2874:
2873:
2871:
2870:
2865:
2864:
2863:
2858:
2848:
2847:
2846:
2841:
2836:
2825:
2823:
2817:
2816:
2813:
2812:
2810:
2809:
2807:Strain pattern
2804:
2803:
2802:
2797:
2792:
2780:
2779:
2778:
2766:
2765:
2764:
2752:
2751:
2750:
2745:
2732:
2730:
2726:
2725:
2723:
2722:
2717:
2712:
2707:
2701:
2699:
2697:Cardiac arrest
2693:
2692:
2690:
2689:
2684:
2679:
2677:Andersen–Tawil
2673:
2671:
2665:
2664:
2662:
2661:
2656:
2651:
2646:
2641:
2631:
2629:
2623:
2622:
2620:
2619:
2614:
2613:
2612:
2602:
2597:
2595:Atrial flutter
2591:
2589:
2582:
2581:
2579:
2578:
2573:
2567:
2565:
2559:
2558:
2556:
2555:
2550:
2545:
2539:
2537:
2533:
2532:
2529:
2528:
2526:
2525:
2520:
2515:
2509:
2507:
2501:
2500:
2498:
2497:
2496:
2495:
2490:
2480:
2479:
2478:
2467:
2465:
2456:
2440:
2439:
2437:
2436:
2431:
2430:
2429:
2424:
2419:
2414:
2409:
2404:
2394:
2389:
2388:
2387:
2382:
2377:
2367:
2358:
2353:
2347:
2345:
2336:
2325:
2324:
2321:
2320:
2317:
2316:
2314:
2313:
2312:
2311:
2306:
2294:
2293:
2292:
2287:
2275:
2274:
2273:
2268:
2256:
2255:
2254:
2249:
2244:
2231:
2229:
2225:
2224:
2222:
2221:
2220:
2219:
2214:
2202:
2201:
2200:
2187:
2185:
2176:
2165:
2164:
2162:
2161:
2156:
2155:
2154:
2149:
2144:
2139:
2134:
2129:
2124:
2119:
2118:
2117:
2105:Cardiomyopathy
2102:
2101:
2100:
2098:Chagas disease
2089:
2087:
2081:
2080:
2078:
2077:
2076:
2075:
2070:
2060:
2059:
2058:
2049:
2038:
2036:
2027:
2023:
2022:
2019:
2018:
2016:
2015:
2014:
2013:
2008:
1998:
1997:
1996:
1986:
1985:
1984:
1979:
1968:
1966:
1960:
1959:
1957:
1956:
1955:
1954:
1949:
1939:
1938:
1937:
1932:
1921:
1919:
1915:
1914:
1912:
1911:
1906:
1901:
1896:
1890:
1885:
1878:
1876:
1869:
1863:
1862:
1854:
1853:
1846:
1839:
1831:
1822:
1821:
1819:
1818:
1813:
1808:
1803:
1797:
1795:
1791:
1790:
1788:
1787:
1786:
1785:
1775:
1769:
1767:
1763:
1762:
1760:
1759:
1753:
1751:
1745:
1744:
1742:
1741:
1736:
1731:
1726:
1720:
1718:
1712:
1711:
1704:
1703:
1696:
1689:
1681:
1673:
1672:
1621:
1590:(5): 135–143.
1570:
1543:(3): 246–251.
1527:
1478:
1422:
1373:
1311:
1260:
1241:
1195:
1135:
1100:
1051:
1018:
997:(4): 543–603.
971:
913:
864:
815:
777:
770:
749:
709:
682:(2): 573–579.
659:
607:
600:
582:
546:
539:
504:
481:
474:
446:
445:
443:
440:
392:
389:
358:
355:
326:
323:
280:
277:
273:cardiac arrest
263:
260:
223:
220:
152:
149:
125:cardiac output
77:
76:
73:
69:
68:
65:
59:
58:
55:
49:
48:
41:
37:
36:
33:
27:
26:
18:
15:
9:
6:
4:
3:
2:
2944:
2933:
2930:
2929:
2927:
2912:
2909:
2907:
2904:
2900:
2897:
2895:
2892:
2891:
2890:
2889:Heart failure
2887:
2885:
2882:
2881:
2879:
2875:
2869:
2866:
2862:
2859:
2857:
2854:
2853:
2852:
2849:
2845:
2842:
2840:
2837:
2835:
2832:
2831:
2830:
2827:
2826:
2824:
2822:
2818:
2808:
2805:
2801:
2800:ST depression
2798:
2796:
2793:
2791:
2788:
2787:
2786:
2785:
2781:
2777:
2774:
2773:
2772:
2771:
2767:
2763:
2760:
2759:
2758:
2757:
2753:
2749:
2746:
2744:
2741:
2740:
2739:
2738:
2734:
2733:
2731:
2727:
2721:
2718:
2716:
2713:
2711:
2708:
2706:
2703:
2702:
2700:
2698:
2694:
2688:
2685:
2683:
2680:
2678:
2675:
2674:
2672:
2670:
2666:
2660:
2657:
2655:
2652:
2650:
2647:
2645:
2642:
2640:
2636:
2633:
2632:
2630:
2628:
2624:
2618:
2615:
2611:
2608:
2607:
2606:
2603:
2601:
2598:
2596:
2593:
2592:
2590:
2588:
2583:
2577:
2574:
2572:
2569:
2568:
2566:
2564:
2560:
2554:
2551:
2549:
2546:
2544:
2541:
2540:
2538:
2534:
2524:
2521:
2519:
2516:
2514:
2511:
2510:
2508:
2506:
2502:
2494:
2491:
2489:
2486:
2485:
2484:
2481:
2477:
2474:
2473:
2472:
2469:
2468:
2466:
2464:
2460:
2457:
2454:
2450:
2445:
2441:
2435:
2432:
2428:
2427:Trifascicular
2425:
2423:
2420:
2418:
2415:
2413:
2410:
2408:
2405:
2403:
2400:
2399:
2398:
2395:
2393:
2390:
2386:
2383:
2381:
2378:
2376:
2373:
2372:
2371:
2368:
2366:
2362:
2359:
2357:
2354:
2352:
2349:
2348:
2346:
2344:
2340:
2337:
2335:
2330:
2326:
2310:
2309:regurgitation
2307:
2305:
2302:
2301:
2300:
2299:
2295:
2291:
2290:regurgitation
2288:
2286:
2283:
2282:
2281:
2280:
2276:
2272:
2271:regurgitation
2269:
2267:
2264:
2263:
2262:
2261:
2257:
2253:
2252:regurgitation
2250:
2248:
2245:
2243:
2240:
2239:
2238:
2237:
2233:
2232:
2230:
2226:
2218:
2215:
2213:
2210:
2209:
2208:
2207:
2203:
2199:
2196:
2195:
2194:
2193:
2189:
2188:
2186:
2184:
2180:
2177:
2175:
2170:
2166:
2160:
2157:
2153:
2150:
2148:
2145:
2143:
2140:
2138:
2135:
2133:
2130:
2128:
2125:
2123:
2120:
2116:
2113:
2112:
2111:
2108:
2107:
2106:
2103:
2099:
2096:
2095:
2094:
2091:
2090:
2088:
2086:
2082:
2074:
2071:
2069:
2066:
2065:
2064:
2061:
2057:
2053:
2050:
2048:
2045:
2044:
2043:
2040:
2039:
2037:
2035:
2031:
2028:
2024:
2012:
2009:
2007:
2004:
2003:
2002:
1999:
1995:
1992:
1991:
1990:
1987:
1983:
1980:
1978:
1975:
1974:
1973:
1970:
1969:
1967:
1965:
1961:
1953:
1950:
1948:
1945:
1944:
1943:
1940:
1936:
1935:Stable angina
1933:
1931:
1928:
1927:
1926:
1923:
1922:
1920:
1916:
1910:
1907:
1905:
1902:
1900:
1897:
1894:
1891:
1889:
1886:
1883:
1880:
1879:
1877:
1873:
1870:
1868:
1864:
1859:
1852:
1847:
1845:
1840:
1838:
1833:
1832:
1829:
1817:
1814:
1812:
1811:Cryptic shock
1809:
1807:
1804:
1802:
1799:
1798:
1796:
1792:
1784:
1783:Osmotic shock
1781:
1780:
1779:
1776:
1774:
1771:
1770:
1768:
1764:
1758:
1755:
1754:
1752:
1750:
1746:
1740:
1737:
1735:
1732:
1730:
1727:
1725:
1722:
1721:
1719:
1717:
1713:
1709:
1702:
1697:
1695:
1690:
1688:
1683:
1682:
1679:
1668:
1664:
1659:
1654:
1649:
1644:
1640:
1636:
1632:
1625:
1617:
1613:
1608:
1603:
1598:
1593:
1589:
1585:
1581:
1574:
1566:
1562:
1558:
1554:
1550:
1546:
1542:
1538:
1531:
1523:
1519:
1514:
1509:
1505:
1501:
1497:
1493:
1489:
1482:
1474:
1470:
1465:
1460:
1455:
1450:
1446:
1442:
1441:Critical Care
1438:
1431:
1429:
1427:
1418:
1414:
1410:
1406:
1401:
1396:
1392:
1388:
1384:
1377:
1369:
1365:
1361:
1357:
1352:
1347:
1343:
1339:
1335:
1328:
1326:
1324:
1322:
1320:
1318:
1316:
1307:
1303:
1298:
1293:
1288:
1283:
1279:
1275:
1271:
1264:
1256:
1252:
1245:
1237:
1233:
1229:
1225:
1221:
1217:
1213:
1209:
1202:
1200:
1191:
1187:
1182:
1177:
1172:
1167:
1163:
1159:
1155:
1148:
1146:
1144:
1142:
1140:
1131:
1127:
1123:
1119:
1115:
1111:
1104:
1096:
1092:
1087:
1082:
1078:
1074:
1070:
1066:
1062:
1055:
1041:
1037:
1033:
1029:
1022:
1014:
1010:
1005:
1000:
996:
992:
985:
978:
976:
967:
955:
941:
937:
933:
932:
924:
922:
920:
918:
909:
905:
901:
897:
892:
887:
883:
879:
875:
868:
860:
856:
852:
848:
843:
838:
834:
830:
826:
819:
805:
801:
797:
793:
786:
784:
782:
773:
767:
763:
756:
754:
739:
735:
731:
727:
720:
718:
716:
714:
705:
701:
697:
693:
689:
685:
681:
677:
670:
668:
666:
664:
655:
651:
646:
641:
637:
633:
629:
625:
621:
614:
612:
603:
597:
593:
586:
572:
568:
564:
560:
553:
551:
542:
536:
532:
525:
523:
521:
519:
517:
515:
513:
511:
509:
500:
496:
492:
485:
477:
471:
467:
466:Critical Care
460:
458:
456:
454:
452:
447:
439:
437:
433:
429:
424:
422:
418:
414:
408:
406:
401:
399:
388:
384:
381:
376:
373:
369:
363:
354:
352:
348:
343:
340:
331:
322:
319:
317:
313:
308:
306:
302:
298:
294:
285:
276:
274:
269:
268:pleural space
259:
257:
253:
249:
248:Hiatal hernia
245:
237:
233:
228:
219:
217:
213:
209:
205:
199:
197:
191:
189:
186:are signs on
185:
181:
180:QRS complexes
177:
173:
169:
164:
160:
158:
148:
146:
142:
141:venous return
136:
134:
130:
126:
122:
117:
115:
111:
107:
103:
99:
95:
91:
90:great vessels
87:
83:
74:
70:
66:
64:
60:
56:
54:
50:
46:
42:
38:
35:Critical Care
34:
32:
28:
23:
2910:
2821:Cardiomegaly
2795:ST elevation
2782:
2768:
2754:
2735:
2639:Ectopic beat
2587:fibrillation
2422:Bifascicular
2296:
2277:
2258:
2234:
2204:
2190:
2183:Endocarditis
2122:Hypertrophic
2056:Constrictive
2042:Pericarditis
2000:
1988:
1971:
1806:Spinal shock
1748:
1724:Septic shock
1716:Distributive
1638:
1634:
1624:
1587:
1583:
1573:
1540:
1536:
1530:
1495:
1491:
1481:
1444:
1440:
1393:(1): 76–92.
1390:
1386:
1376:
1341:
1337:
1277:
1273:
1263:
1254:
1244:
1211:
1207:
1161:
1157:
1113:
1109:
1103:
1068:
1064:
1054:
1043:. Retrieved
1031:
1021:
994:
990:
943:. Retrieved
930:
881:
877:
867:
835:(3): 35–37.
832:
828:
818:
807:. Retrieved
795:
761:
741:. Retrieved
729:
679:
675:
627:
623:
591:
585:
574:. Retrieved
562:
530:
499:the original
494:
484:
465:
428:thrombolysis
425:
409:
402:
394:
385:
377:
364:
360:
344:
336:
320:
309:
290:
265:
241:
200:
192:
168:Beck's triad
165:
161:
154:
137:
118:
81:
80:
2687:Romano–Ward
2654:Parasystole
2553:Ventricular
2505:Ventricular
2444:Tachycardia
2361:Heart block
2343:Bradycardia
2169:Endocardium
2132:Restrictive
2093:Myocarditis
2034:Pericardium
1801:Cardiogenic
1778:Hypovolemia
1749:Obstructive
1116:(1): 5–24.
962:|work=
432:embolectomy
372:Lactic acid
347:pericardium
275:and death.
236:mediastinal
216:Wells score
114:tachycardia
2585:Flutter /
2548:Junctional
2483:Junctional
2476:Multifocal
2449:paroxysmal
2365:Sinoatrial
2334:arrhythmia
2329:Conduction
2085:Myocardium
1773:Hemorrhage
1766:Low-volume
1447:(1): 275.
1164:(1): 124.
1045:2021-11-08
1032:StatPearls
945:2021-10-27
809:2021-10-28
796:StatPearls
743:2021-10-26
730:StatPearls
576:2021-10-28
563:StatPearls
442:References
398:intubation
212:hemoptysis
2844:Pulmonary
2627:Pacemaker
2298:pulmonary
2279:tricuspid
2115:Alcoholic
1565:133607214
1417:210132213
1110:Radiology
964:ignored (
954:cite book
859:109167732
851:1558-447X
436:alteplase
391:Treatment
357:Diagnosis
250:, severe
157:tachypnea
145:afterload
133:perfusion
72:Treatment
31:Specialty
2926:Category
2710:Asystole
2610:Familial
2304:stenosis
2285:stenosis
2266:stenosis
2247:stenosis
2242:prolapse
1964:Sequelae
1867:Ischemia
1667:26320112
1616:21666814
1557:31022087
1522:17639117
1473:27543137
1409:31918837
1360:24171518
1306:28484689
1236:23963678
1228:29137910
1190:32953201
1130:28628412
1095:32809909
1040:29939530
1013:31504429
940:32809386
900:25563887
804:28613742
738:32644516
704:23603180
696:23263572
654:30573009
571:30285387
417:catheter
305:Covid-19
232:tracheal
204:ischemia
2110:Dilated
2052:Chronic
1860:(heart)
1658:7539677
1607:3110902
1513:1994428
1464:4992302
1368:6900105
1297:5401877
1181:7492788
1086:7660782
908:1472242
645:6323133
559:"Shock"
208:syncope
92:or the
2790:J wave
2543:Atrial
2471:Atrial
2260:aortic
2236:mitral
2228:Valves
2174:valves
2026:Layers
1895:(SCAD)
1665:
1655:
1614:
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222:Causes
104:, and
40:Causes
2877:Other
2861:Right
2839:Right
2453:sinus
2402:Right
2152:Viral
2047:Acute
2001:weeks
1972:hours
1884:(CAD)
1794:Other
1708:Shock
1561:S2CID
1492:Heart
1413:S2CID
1364:S2CID
1232:S2CID
1208:Chest
987:(PDF)
904:S2CID
855:S2CID
700:S2CID
351:liter
256:aorta
94:heart
86:shock
2856:Left
2834:Left
2451:and
2407:Left
1989:days
1663:PMID
1612:PMID
1553:PMID
1518:PMID
1469:PMID
1405:PMID
1356:PMID
1302:PMID
1224:PMID
1186:PMID
1126:PMID
1091:PMID
1036:PMID
1009:PMID
966:help
936:PMID
896:PMID
847:ISSN
800:PMID
766:ISBN
734:PMID
692:PMID
650:PMID
596:ISBN
567:PMID
535:ISBN
470:ISBN
234:and
210:and
182:and
174:and
1653:PMC
1643:doi
1602:PMC
1592:doi
1545:doi
1508:PMC
1500:doi
1459:PMC
1449:doi
1395:doi
1346:doi
1342:369
1292:PMC
1282:doi
1216:doi
1212:153
1176:PMC
1166:doi
1118:doi
1114:284
1081:PMC
1073:doi
999:doi
886:doi
882:261
837:doi
684:doi
640:PMC
632:doi
628:115
430:or
198:).
188:EKG
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2756:QT
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