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Cardiac Tamponade — EECC MCQ

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EasyPericardial DiseaseCardiac TamponadeEECC

A 58-year-old man presents with hypotension (BP 75/50 mmHg), tachycardia (HR 120 bpm), elevated JVP, and muffled heart sounds. Echocardiography shows a large pericardial effusion with RV diastolic collapse. What is the most appropriate immediate intervention?

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Correct answer: C — Emergency pericardiocentesis

This is cardiac tamponade (Beck's triad: hypotension, elevated JVP, muffled heart sounds) with echocardiographic confirmation (RV diastolic collapse). Emergency pericardiocentesis is the life-saving intervention (Class I). It is typically performed under echocardiographic guidance via the subxiphoid approach. IV fluid resuscitation may be a temporising measure to increase preload, but definitive drainage is urgent. Diuretics are contraindicated as they reduce preload and worsen tamponade physiology. The 2025 ESC Myocarditis/Pericarditis Guidelines recommend pericardiocentesis for cardiac tamponade as an emergency procedure. Pericardial fluid should be sent for biochemistry, cytology, and microbiology.

Reference: ESC (2025): Guidelines for the Management of Myocarditis and Pericarditis