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Iatrogenic Cardiac Tamponade — EECC MCQ

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ModeratePericardial DiseaseIatrogenic Cardiac TamponadeEECC

A 55-year-old man presents with sudden haemodynamic collapse after a central line insertion. He becomes hypotensive (BP 60/40), tachycardic (HR 130), with muffled heart sounds and distended neck veins. Point-of-care echo shows a pericardial effusion with RV diastolic collapse. What is the diagnosis and immediate management?

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Correct answer: A — Cardiac tamponade from iatrogenic cardiac perforation — emergency pericardiocentesis (or surgical drainage) is life-saving; Beck's triad (hypotension, muffled heart sounds, elevated JVP) is the classic presentation, though the full triad is present in only ~30% of cases

Cardiac tamponade is a medical emergency where pericardial fluid accumulation compresses the cardiac chambers, preventing diastolic filling. Iatrogenic causes (central line, pacemaker implant, cardiac catheterisation) are increasingly common. Haemodynamic features: (1) Beck's triad: hypotension, muffled heart sounds, elevated JVP (present in ~30%); (2) pulsus paradoxus (>10 mmHg inspiratory SBP drop); (3) electrical alternans on ECG; (4) echo: RV diastolic collapse, RA systolic collapse, IVC plethora, respirophasic flow variation. Emergency management: (1) IV fluid bolus (increases preload to maintain some filling); (2) AVOID: positive pressure ventilation (reduces preload further), diuretics, vasodilators; (3) emergency pericardiocentesis (subxiphoid approach under echo guidance — gold standard) or surgical drainage (pericardial window). For iatrogenic tamponade, the effusion is often haemorrhagic and may accumulate rapidly.

Reference: ESC (2025): Myocarditis/Pericarditis Guidelines