Cardiovascular · UKMLA & AKT
Cardiac tamponade
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
Key high-yield points
- Beck's triad - hypotension + raised JVP + muffled heart sounds (all three present together in only a minority of cases)
- Pulsus paradoxus - exaggerated fall in systolic BP (>10 mmHg) during normal inspiration; hallmark sign of tamponade
- Tachycardia - early compensatory response to falling stroke volume
- Hypotension - late and ominous, indicates decompensation
- Raised JVP - venous back-pressure from impaired right heart filling
- Dyspnoea - most common symptom
- Kussmaul's sign is ABSENT - JVP rises on inspiration in constrictive pericarditis but NOT in tamponade; key differentiating feature
Pulsus paradoxus mechanism: inspiration causes right ventricle to fill preferentially; in tamponade, RV expansion shifts the interventricular septum leftwards (ventricular interdependence), reducing LV filling and stroke volume - systolic BP falls >10 mmHg. The two ventricles compete for space inside a non-compliant sac.
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