Review Question - QID 100664

The patient in this scenario is suffering from cardiac tamponade, as evidenced by the findings of an enlarged cardiac silhouette and pulsus paradoxus. Immediate evacuation of the pericardial sac is essential to prevent hemodynamic collapse.

Pulsus paradoxus is an exaggeration of the normal variation in systolic blood pressure with inspiration, defined as a decrease in systolic blood pressure of >10mm of Hg during inspiration. The "paradox" is that one can detect beats on cardiac auscultation during inspiration that cannot be palpated at the radial pulse. These physical exam findings are found in cardiac tamponade due to the pressure placed on the heart by the fluid filled pericardial cavity. Beck's triad (jugular venous distension, distant heart sounds, hypotension) are exam findings that are consistent with the diagnosis of cardiac tamponade.

Incorrect Answers:
Answer 1: IV Heparin may be given if there is suspicion of a thrombotic event. However, in this scenario it has the potential to be a dangerous mistake as it would likely increase the quantity of fluid in the pericardial space.
Answer 3: Cardiac tamponade is an emergency that must be intervened upon immediately and thus once diagnosed clinically requires no further workup.
Answer 4: A pericardial window is indicated for recurring fluid accumulation after aspiration is attempted or when infectious causes are suspected.
Answer 5: Chest tube insertion is an appropriate treatment for hemothorax or pneumothorax. It would not be appropriate in this clinical scenario, unless other traumatic findings were identified.