SAQ 448 – Cardiology – pericardial tamponade with hypotension

Cardiology – pericardial tamponade with hypotension.

a. Cause

• Restricted cardiac output from pericardial tamponade.

b. ECG findings

• Sinus tachycardia.
• Electrical alternans of the QRS complexes.
• Low voltage, especially across the precordial leads.
• PR elevation in aVR.
• PR depression, especially in lead II.

c. Focused ultrasound

• Pericardial fluid/dark stripe around the heart.
• Reduced chamber filling.
• Early diastolic right ventricular collapse.
• Late diastolic right atrial collapse.
• Respiratory variation in mitral and tricuspid inflow.
• Dilated, non-collapsing IVC.

d. Interventions

• Cautious IV fluid loading while definitive drainage is arranged.
• Vasopressors or inotropes to support perfusion.
• Urgent pericardiocentesis.
• Surgical pericardial window or other definitive drainage where required.