Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets and reassess frequently.
- Plan definitive source control or disease‑specific therapy when indicated; document follow‑up and patient education.
Algorithm
- Recognize clinical/POCUS signs; call for experienced operator.
- Stabilize with fluids and avoid PPV if possible; perform urgent pericardiocentesis.
- Treat cause (malignancy, TB, post-op) and plan for recurrence prevention.
Clinical Synopsis & Reasoning
Beck’s triad and pulsus paradoxus with effusion on ultrasound suggests tamponade. Provide IV fluids as a bridge, avoid positive-pressure ventilation if possible, and perform urgent pericardiocentesis with echo guidance; reverse anticoagulation and treat underlying cause.
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced/procedural interventions based on explicit failure criteria. Define ICU, step‑down, and ward disposition triggers; involve specialty teams early.
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitants; see citations for condition‑specific data.
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|
| Point-of-care ultrasound (RA/RV diastolic collapse, plethoric IVC) | Diagnosis | Classic signs | Rapid bedside confirmation |
| ECG and CXR | Adjuncts | Low voltage, electrical alternans; enlarged silhouette | — |
| Coagulation studies and type & cross | Preparation | Procedure planning | — |
High-Risk & Disposition Triggers
| Trigger | Why it matters | Action |
|---|
| Hypotension with pulsus paradoxus and JVD | Hemodynamic collapse | Immediate pericardiocentesis; ICU |
| Post-cardiac surgery or trauma | Complex effusion | Surgical consultation |
| Anticoagulation or coagulopathy | Bleed risk | Reverse before procedure if possible |
| Suspected purulent/tuberculous pericarditis | Infection risk | Drain and targeted antibiotics |
| Large effusion with signs of impending tamponade | Deterioration risk | Urgent drainage planning |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|
| Urgent pericardiocentesis with catheter drainage | Definitive | Minutes‑hours | Relieve hemodynamic compromise | Surgical window for recurrent/loculated |
| IV fluids (temporary) | Preload support | Minutes | Stabilize while arranging drainage | Use judiciously |
| Reverse anticoagulation (vitamin K/PCC) | Bleeding control | Hours | Reduce reaccumulation/bleed | — |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy; monitor for complications.
Patient Education / Counseling
- Provide red‑flag education, adherence guidance, and explicit return precautions; arrange timely specialty follow‑up.
References
- Pericardial disease guidelines — Link