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Cardiac tamponade — SCE Acute Medicine MCQ

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ModerateAcute Cardiac PresentationsCardiac tamponadeSCE Acute Medicine

A 63-year-old woman presents with acute chest symptoms with haemodynamic concern. Relevant history includes cardiovascular risk factors or structural heart disease. On assessment, haemodynamic findings and ECG changes are present. Investigations show hypotension, raised JVP and right atrial collapse on echo. What is the most appropriate next step in management?

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Correct answer: A — Perform urgent ultrasound-guided pericardiocentesis

The key discriminator is that hypotension, raised JVP and right atrial collapse on echo, which makes Perform urgent ultrasound-guided pericardiocentesis the single best answer. Give controlled oxygen and senior review is less appropriate because it does not address the dominant acute risk in the vignette; Arrange urgent CT imaging would fit a different presentation or later stage of care. Arrange urgent specialist referral and Start broad-spectrum intravenous antibiotics are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: ESC pericardial disease guideline