Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive dyspnea, orthopnea, and chest pressure. Reports symptoms worsening with recumbency and improving with leaning forward. No history of recent trauma, fever, or viral prodrome. Denies syncope, but reports lightheadedness upon exertion.
Clinical Examination Findings
Vitals: Tachycardic, tachypneic, pulsus paradoxus noted >10 mmHg. Cardiovascular: Muffled heart sounds, point of maximal impulse difficult to palpate. JVP: Elevated with prominent 'x' descent. Lungs: Clear to auscultation, no crackles. Extremities: No peripheral edema.
Treatment Protocol
Immediate echocardiographic assessment for tamponade physiology. Urgent pericardiocentesis indicated for large symptomatic effusion. Initiate hemodynamic monitoring, supplemental oxygen, and fluid resuscitation if hypotensive. Consider surgical pericardial window if recurrent.