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Tamponade Supportive Care — SCE Medical Oncology MCQ

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ModerateOncological EmergenciesTamponade Supportive CareSCE Medical Oncology

A 62-year-old man with cancer develops acute pericardial tamponade. Echo confirms a large circumferential effusion with diastolic collapse of the right ventricle. He is hypotensive (BP 80/60) with pulsus paradoxus. While awaiting pericardiocentesis, what supportive measure helps maintain cardiac output?

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Correct answer: B — IV fluid bolus to maintain right ventricular filling pressure

In cardiac tamponade, the heart is unable to fill adequately due to external pericardial pressure. Cardiac output is maintained by increased heart rate (tachycardia is a compensatory mechanism — beta-blockers are contraindicated) and adequate venous return (preload). IV fluid bolus helps maintain right ventricular filling pressure while awaiting definitive pericardiocentesis. Diuretics, nitrates and any preload-reducing agents are CONTRAINDICATED as they worsen tamponade physiology. Positive-pressure ventilation (intubation) can also worsen tamponade and should be avoided if possible.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer