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Malignant cardiac tamponade — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsMalignant cardiac tamponadeSCE Acute Medicine

A 45-year-old woman with metastatic breast cancer presents with progressive dyspnoea and presyncope. BP is 86/58 mmHg, HR 124, JVP is elevated and heart sounds are quiet. ECG shows low voltage complexes and bedside echocardiography shows a large pericardial effusion with right atrial collapse. What is the most appropriate next step in management?

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Correct answer: E — Arrange urgent ultrasound-guided pericardiocentesis

This is cardiac tamponade with obstructive shock, and urgent pericardial drainage is needed. Diuresis can reduce preload and worsen haemodynamic compromise. PE is a differential but the echocardiographic right atrial collapse with large effusion identifies the immediate problem. In tamponade, bedside echo is enough to guide life-saving intervention.

Reference: ESC pericardial disease guideline, Resuscitation Council UK ALS