Case vignette
34yo F recently diagnosed with SLE presents with 1-2 of progressive SOB and pleuritic CP. She denies F/C or cough but has had joint pain. Your medical student performed a cardiac US and states there's a pericardial effusion, but this can't be tamponade because it's small.
HR 122, BP 98/50, RR 22, SpO2 94, T 37.8.
Uncomfortable appearing female with clear lungs and +JVD.
What do you see?
CP5 PLA 1: RV diastolic collapse and notching
CP5 PLA 2: M-mode with RV wall collapse during diastole (cycles identified by movement of MV)
CP5 PSA: "man jumping on trampoline" sign, abnormal RV motion
CP5 Apical 4: RA systolic collapse (a sensitive finding!)
CP5 Apical 4 (2nd): RA systolic collapse (a sensitive finding!)
What do you do next?
You correctly identify multiple signs of tamponade, initiate a fluid bolus, and consult cardiology for emergent pericardiocentesis. The patient stabilzies with fluids and is admitted to the cath lab, where a drain is successfully placed (initial removal of ~150mL serous fluid).
Teaching points. As little as 100-200mL of pericardial fluid can cause tamponade if it accumulates quickly. Do not let a small effusion dissuade you from assessing for the diagnosis; look for additional US findings of tamponade as above, as well as clinical findings such as Beck's triad (low sensitivity) and pulsus paradoxus (when possible).
Residents/staff: Dr. Kyle Buchwalder
Tamponade