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Cardiac tamponade — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsCardiac tamponadeSCE Acute Medicine

A 44-year-old woman receiving chemotherapy presents with progressive dyspnoea and presyncope. Blood pressure is 86/54 mmHg, JVP is elevated and heart sounds are quiet. ECG shows low-voltage QRS complexes with electrical alternans. Bedside echo shows a large pericardial effusion with right atrial collapse. What is the most appropriate next step in management?

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Correct answer: A — Urgent echo-guided pericardiocentesis

The presentation is cardiac tamponade causing obstructive shock, requiring urgent pericardial drainage. Diuretics can reduce preload and worsen shock. Anticoagulation would be hazardous without evidence of PE and may worsen haemorrhagic effusion. The pearl is that echo signs plus clinical shock make tamponade a drainage diagnosis, not an observation diagnosis.

Reference: ESC Pericardial Diseases guideline