Pericardial effusion is the collection of fluid around the heart. In this brief article, we will be discussing the signs of pericardial effusion on physical examination.

Following are the 4 signs of pericardial effusion. 

1. Pulsus Paradoxus. 

    Pulsus Paradoxus, means a decrease in systolic blood pressure of more than 10mm of Hg during inspiration. The fall occurs due to increase in intrathoracic negative pressure during inspiration. In cardiac tamponade, Pulsus Paradoxus is exaggerated and a fall of more than 10 mm of Hg occurs during inspiration. An arterial line for blood pressure measurement is a good tool to measure inspiratory and expiratory blood pressures. 

2. Ewart's sign

    In case of a large pericardial effusion, dullness is present below the left scapular angle along with bronchial breathing. this sign is called Ewart's sign. 

3. Increased Cardiac dullness. 

    The area of cardiac dullness increases upon the percussion of the anterior chest due to a large pericardial effusion. 

4. Kussmaul sign. 

    Normally JVP rises during expiration and falls during inspiration due to a decrease in chest pressure because the thoracic cavity expands during inspiration. But in Kussmaul sign, JVP doesn't fall during inspiration. 

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