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Cardiac tamponade due to pericardial effusion — MRCEM SBA MCQ

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EasyCardiovascular emergenciesCardiac tamponade due to pericardial effusionMRCEM SBA

A 46-year-old woman presents with worsening breathlessness and light-headedness following four days of pleuritic chest discomfort. She is alert but clammy. Her blood pressure is 78/50 mmHg, heart rate 124/min and oxygen saturation 96% on air. Her jugular venous pressure is raised and her lungs are clear. Bedside echocardiography shows a large circumferential pericardial effusion with right ventricular diastolic collapse. There has been no trauma or recent cardiac procedure. Cardiac monitoring and intravenous access are established, and a clinician experienced in ultrasound-guided pericardiocentesis is available. Which initial management plan is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Arrange immediate ultrasound-guided pericardiocentesis with specialist support.

Hypotension and a raised jugular venous pressure indicate impaired circulation; the large effusion with right ventricular diastolic collapse identifies cardiac tamponade as its cause. She needs urgent pericardial drainage, not observation while further tests or medical treatment are undertaken. Ultrasound-guided pericardiocentesis by an experienced clinician is the appropriate immediate intervention. She should then have repeat clinical and echocardiographic assessment, monitoring for re-accumulation, and admission to an appropriate critical care area while the cause is investigated. ([doclibrary-rcht.cornwall.nhs.uk](https://doclibrary-rcht.cornwall.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Clinical/Cardiology/CardiacTamponadeManagementClinicalGuideline.pdf?utm_source=openai)) **A** delays treatment of an established cause of shock; CT pulmonary angiography would be more useful if pulmonary embolism remained the leading diagnosis. **B** is tempting because a fluid bolus may temporarily support circulation, but it does not relieve tamponade or justify postponing drainage. **C** could address uncomplicated inflammatory pericarditis without haemodynamic compromise; it cannot treat tamponade. **D** may become appropriate for recurrent or difficult-to-drain effusions, but transfer for surgery would delay the available, suitable immediate drainage procedure in this case. ([bradfordhospitals.nhs.uk](https://www.bradfordhospitals.nhs.uk/wp-content/uploads/2019/06/3-9-Cardiac-tamponade.pdf?utm_source=openai))

Reference: Cardiac Tamponade Management Clinical Guideline (Version 2.0; listed as valid to 09 October 2026) — https://doclibrary-rcht.cornwall.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Clinical/Cardiology/CardiacTamponadeManagementClinicalGuideline.pdf Cardiac tamponade (2018; NHS-hosted PDF dated 2019) — https://www.bradfordhospitals.nhs.uk/wp-content/uploads/2019/06/3-9-Cardiac-tamponade.pdf