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Cardiac Tamponade — RACP Adult Medicine MCQ

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ModerateEmergency MedicineCardiac TamponadeRACP Adult Medicine

A 55-year-old man presents with a large pericardial effusion on echocardiography. He has a Beck's triad (hypotension, raised JVP, muffled heart sounds). ECG shows electrical alternans and low voltage complexes. What is the most urgent intervention?

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Correct answer: D — Diuretics to reduce preload

Beck's triad with electrical alternans (alternating QRS amplitude due to heart swinging in a large effusion) indicates cardiac tamponade, which is a medical emergency. Pericardiocentesis (typically echocardiography-guided, subxiphoid approach) is the most urgent life-saving intervention. IV fluids may temporarily support preload. Diuretics and vasodilators are CONTRAINDICATED as they reduce preload. Positive pressure ventilation should also be avoided if possible as it further compromises venous return.

Reference: eTG – 2025 – Cardiovascular; ESC – 2015 – Pericardial Diseases Guidelines