Other frequent symptoms are pulsus paradoxus, pericardial friction sounds, tachycardia, tachypnea, weakened peripheral pulses, edema, cyanosis. This causes adverse hemodynamic effects, and the condition is classified as cardiac tamponade. The classical signs of cardiac tamponade are hypotension, muffled heart sounds and jugular venous distention. Intrapericardial pressure may reach the point where the ventricles and atria can no longer relax normally, and the ventricles may even be compressed during diastole. Intrapericardial pressure increases as fluid accumulates in the pericardial space. The patient's confusion, while not typical of acute PE, has been recognized in the historical literature, with up to 5 displaying some form of neurological manifestation. Hemodynamic effects of pericardial effusion and cardiac tamponade The clinical presentation of hypoxia and relative hypotension on a background of malignancy, recent surgery and significant ECG changes were quite concerning for possible PE. Because it is difficult to determine if there is also myocarditis (which is frequent), it is common to use the term perimyocarditis. The most common cause of pericardial effusion is pericarditis.
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