A. Echocardiogram – Explanation
This question clearly points towards cardiac tamponade. His chest is bilaterally clear thus we can
therefore exclude pneumothorax or pleural effusion. Muffled heart sounds, distended neck veins,
hypotension are called Beck’s triad and it is a classical finding in cardiac tamponade. This is diagnosed
with an echocardiogram.
COMPARING COMMON FEATURES OF ACUTE PERICARDITIS, PERICARDIAL EFFUSION,
CARDIAC TAMPONADE
These are the most common features that are asked in exams
| Condition | Acute Pericarditis | Pericardial Effusion | Cardiac Tamponade |
| Cause | Causes include – Viral infections (Coxsackie) – Tuberculosis – Uraemia – Trauma – Post-myocardial infarction (Dressler’s syndrome) – Connective tissue disease |
Any cause of pericarditis | Any cause of pericarditis, especially trauma |
| Clinical Features | Central chest pain worse on inspiration or lying flat, relieved by sitting forward Pericardial friction rub Dyspnoea |
– Raised JVP – Pulse ↑ – BP ↓ – Muffled heart sounds |
Beck’s triad: Falling BP, rising JVP, muffled heart sounds |
| Test | ECG: Concave (saddle-shaped) ST segment elevation Troponin may be raised |
CXR: Enlarged, globular heart ECG: Low-voltage QRS complexes, alternating |
Echo is diagnostic |
| Treatment | NSAIDs | Pericardiocentesis | Urgent Pericardiocentesis |
CARDIAC TAMPONADE
A life-threatening condition in which a pericardial effusion has developed so rapidly or has become so
large that it compresses the heart.
Etiology
-
- Usually penetrating or blunt chest trauma
Features
- Dyspnoea
- Raised JVP – seen by having neck veins which are distended
- Tachycardia
- Hypotension
- Muffled heart sounds
- Pulsus paradoxus
Remember → Beck’s triad: Muffled heart sounds, distended neck veins, and hypotension
Diagnosis
Echocardiography
Treatment
-
- Pericardiocentesis
