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Post-cardiac surgery tamponade — FRCA Final MCQ

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HardCardiothoracic and Vascular AnaesthesiaPost-cardiac surgery tamponadeFRCA Final

A 66-year-old woman is two hours post-CABG in cardiac ICU. She becomes hypotensive with rising central venous pressure, narrowing pulse pressure, falling urine output and increasing drain output suddenly stops. Echocardiography shows right atrial compression. What is the most likely cause of the complication?

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Correct answer: D — Cardiac tamponade from postoperative bleeding and clot

Rising filling pressures, hypotension, low output and cessation of drain output after cardiac surgery strongly suggest tamponade from clot obstructing drainage. Vasoplegia causes low systemic resistance but not chamber compression. Tension pneumothorax is a differential but echo evidence of right atrial compression points to tamponade. Urgent surgical re-exploration is usually required.

Reference: Association for Cardiothoracic Anaesthesia and Critical Care guidance; RCoA Final FRCA Syllabus 2026