Clinical features

Symptoms include:

• fatigue
• breathlessness is not severe and, characteristically, occurs on exertion and not at rest
• swelling of abdomen and ankles - ascites is more prominent feature than peripheral oedema

Signs include:

• small pulse:
  • pulsus paradoxus
  • atrial fibrillation
  • tachycardia
• Kussmaul's sign (a raised JVP with inspiration); dominant y descent and trough
• cardiac impulses: barely palpable; characteristic is systolic retraction at the apex
• pericardial knock (loud-high pitched S3) following S2
• hepatomegaly
• ascites
• ankle swelling

Reference:

• Braunwald E (2011). Heart Disease - A Textbook of Cardiovascular Medicine,WB Saunders.