Adult-Gerontology Acute Care Nurse Practitioner Certification Review Cardiology | Questions & Answers
2. Which of the following are the main components of 4. Hypotension, muffled heart sounds, jugular venous distension.
the Beck triad in cardiac tamponade? Rationale: Beck's triad alerts clinicians that cardiac tamponade is potentially
1. Hypotension, electrical alternans, prominent x- present. The main components of cardiac tamponade are hypotension, muffled
descent in neck veins. heart sounds, and jugular venous distension. This triad is often associated with
2. Muffled heart sounds, friction rub, hypotension. prominent x-descent and absent y-descent and pulsus paradoxus. These
3. Jugular venous distension, Kussmaul sign, electrical features are caused by failure of ventricular filling and limited cardiac output.
alternans. The Kussmaul sign is seen in restrictive cardiomyopathy and constrictive
4. Hypotension, muffled heart sounds, jugular venous pericarditis. A friction rub can be seen in any condition associated with
distension. pericardial inflammation.
3. A 66-year-old man, known to have melanoma, 3. A greater than 10 mmHg drop in his systolic blood pressure with
presents to the emergency department with dizziness inspiration.
and shortness of breath for that last 3 days. On exam Rationale: This patient most likely has a developing cardiac tamponade from a
his blood pressure is 80/50 mmHg. He has muffled previously formed pericardial effusion. Melanoma is a known tumor to infiltrate
heart sounds and pedal edema. Chest x-ray revealed the pericardium. Cardiac tamponade is characterized by increased jugular
an enlarged cardiac silhouette. Which of the following venous pressure, muffled heart sounds, hypotension, and pulsus paradoxus
is most likely true of his physical exam? (greater than 10 mmHg drop in systolic blood pressure with inspiration). Answer
1. Clear lungs with decreased jugular venous pressure 1 is not correct because the JVP increases. A pericardial knock is more likely to
(JVP). be noted in constrictive pericarditis.
2. Increased JVP with inspiration.
3. A greater than 10 mmHg drop in his systolic blood
pressure with inspiration.
4. Pericardial knock.
4. A 70-year-old woman, known to have breast cancer, 3. Varied QRS complex from beat to beat.
presents to the emergency department with a sudden Rationale: This patient most likely has cardiac tamponade, which is
attack of syncope. On exam she is hypotensive, blood characterized by altered and varied QRS complexes from beat to beat caused
pressure (BP) is 75/50 mmHg, bilateral vesicular by the heart swinging in the accumulating fluid in the pericardial cavity.
breathing with no added sounds are heard on
auscultation of the chest, distant heart sounds, and
more than 10 mmHg drop of systolic BP with inspiration.
Which of the following findings is most probably seen
on electrocardiogram when requested?
1. Prolonged PR interval with dropped P-wave.
2. Widespread ST elevation.
3. Varied QRS complex from beat to beat.
4. Delta wave in almost all leads.
5. All of the following physical findings could be found 4. None of the above.
in cardiac tamponade, except: Rationale: Cardiac tamponade is associated with sinus tachycardia in almost all
1. Sinus bradycardia. cases, but sinus bradycardia could be found in subacute cardiac tamponade
2. Sinus tachycardia. associated with hypothyroidism. The Beck triad (hypotension, increased jugular
3. Increased jugular venous pressure. venous pressure, muffled heart sounds), pulsus paradoxus, and peripheral
4. None of the above. edema also are present in patients with cardiac tamponade.
, Adult-Gerontology Acute Care Nurse Practitioner Certification Review Cardiology | Questions & Answers
6. All of the following sentences are true about cardiac 3. Beck triad (hypotension, increased jugular venous pressure, muffled heart
tamponade, except: sounds) is present in almost all patients with cardiac tamponade.
1. Acute cardiac tamponade occurs within minutes and it Rationale: All the previous facts are true about cardiac tamponade except that
can be caused by trauma. the Beck triad, which consists of hypotension, elevated jugular venous
2. Subacute cardiac tamponade occurs within days to pressure, and muffled heart sounds, is present in only a minority of patients.
weeks and it can be caused by neoplasm.
3. Beck triad (hypotension, increased jugular venous
pressure, muffled heart sounds) is present in almost all
patients with cardiac tamponade.
4. Cardiomegaly associated with acute cardiac
tamponade is not usually seen on a chest x-ray until 200
mL fluid accumulates in the pericardial sac.
7. Which of the following drugs is involved in cardiac 4. Procainamide.
tamponade formation? Rationale: Drug-induced cardiac tamponade is rare. Procainamide, isoniazid,
1. Corticosteroids. and hydralazine (drug-induced lupus) are involved in cardiac tamponade
2. Ranitidine. formation. Others drugs found in drug-induced cardiac tamponade include
3. Amiodarone. dantrolene, anticoagulants, thrombolytics, phenytoin, penicillin, and
4. Procainamide. doxorubicin.
8. A 69-year-old man presents to the emergency 2. Urgent catheter pericardiocentesis.
department with a sudden attack of syncope. On exam, Rationale: This patient with suspected acute cardiac tamponade is
his blood pressure is 70/45 mmHg. He has muffled hemodynamically unstable. Both catheter pericardiocentesis and surgical
heart sounds, pulsus paradoxus, and peripheral edema. drainage of a pericardial effusion are highly effective at removal of pericardial
The chest x-ray reveals an enlarged cardiac silhouette. fluid. Catheter pericardiocentesis is the treatment of choice because it is less
He was diagnosed with lung cancer 3 years ago. Which invasive, less expensive, and does not need general anesthesia, which may
of the following is most correct management step for worsen the hemodynamic compromise if needle drainage is not performed
this patient? first to reduce the severity of the cardiac tamponade.
1. Giving streptokinase immediately.
2. Urgent catheter pericardiocentesis.
3. Percutaneous coronary intervention within minutes.
4. Immediate open cardiac surgery.
9. A 70-year-old man presented to the emergency 4. Immediate open cardiac surgery.
department with a sudden attack of syncope after Rationale: This patient with a previous history of diabetes mellitus, hypertension,
experiencing severe chest pain that radiated to his and long history of heavy smoking with presentation of sudden stabbing back
back. He described the pain as like being stabbed with pain, severe hypotension, muffled heart sounds, and increased jugular venous
a knife. He is known to have type 2 diabetes and pressure is most likely suffering from aortic dissection complicated by cardiac
hypertension. He has been a heavy smoker since he tamponade. Aortic dissection and myocardial rupture are contraindications for
was young. On exam, his blood pressure is 70/40 catheter pericardiocentesis because the relief of cardiac tamponade may lead
mmHg. He has muffled heart sounds, pulsus paradoxus, to more severe bleeding. Such patients require immediate surgical intervention.
and increased jugular venous pressure. Which of the
following is the most correct next step for the
management of this patient?
1. Giving streptokinase immediately.
2. Urgent catheter pericardiocentesis.
3. Percutaneous coronary intervention within minutes.
4. Immediate open cardiac surgery.
,Adult-Gerontology Acute Care Nurse Practitioner Certification Review Cardiology | Questions & Answers
10. A 32-year-old male patient developed viral 2. He is likely to demonstrate Kussmaul sign.
pericarditis 1 month ago. He was relatively Rationale: This patient with a history of acute pericarditis now presents with
asymptomatic and just complaining of mild chest pain. cardiac tamponade, which occurs in 15% of cases of acute pericarditis. He is
He was treated with ibuprofen as an outpatient. He now unlikely to have Kussmaul sign (increase un jugular venous pressure with
presents to the emergency department with new-onset inspiration) because this is usually seen in constrictive pericarditis. The other
dizziness and dyspnea. His blood pressure is 90/50 choices are true, and all can be found in cardiac tamponade.
mmHg. He has muffled heart sounds and elevated
jugular venous pressure. Which of the following
statements is false?
1. Echocardiogram is unlikely to show a thickened
pericardium.
2. He is likely to demonstrate Kussmaul sign.
3. His electrocardiogram is likely to show reduced
voltage or electrical alternans.
4. He is likely to have a pulsus paradoxus.
1. Which of the following is the most sensitive sign in 1. Drop in systolic blood pressure (BP) more than 10 mmHg during inspiration.
patients with cardiac tamponade? Rationale: Pulsus paradoxus (drop in systolic blood pressure [SBP] more than
1. Drop in systolic blood pressure (BP) more than 10 10 mmHg during inspiration) is the most sensitive sign in cardiac tamponade. A
mmHg during inspiration. drop in SBP more than 20 mmHg while changing the position of the patient is
2. Drop in systolic BP more than 20 mmHg during characteristic for orthostatic hypotension. Distant heart sounds can be found in
changing the position of the patient. cardiac tamponade, but it is not the most sensitive sign.
3. Distant heart sounds.
4. Absent radial pulse during inspiration.
12. A 72-year-old man presents to the emergency 4. Intravenous fluids.
department with a sudden attack of shortness of breath Rationale: This patient with cardiac tamponade is hemodynamically unstable
and dizziness. On exam his blood pressure is 75/35 and preload dependent. He should not be given diuretics, nitrates, or
mmHg. He has distant heart sounds, pulsus paradoxus, morphine because they could exacerbate his compromise. The patient should
and peripheral edema. Chest x-ray revealed an be supported with intravenous fluid while waiting for the pericardiocentesis to
enlarged cardiac silhouette. He was diagnosed with protect him from more deterioration.
lung cancer 5 years ago. While awaiting
pericardiocentesis, what does immediate supportive
care for this patient with cardiac tamponade include?
1. Diuresis with furosemide.
2. Nitrates to lower venous congestion.
3. Morphine to relieve dyspnea.
4. Intravenous fluids.
, Adult-Gerontology Acute Care Nurse Practitioner Certification Review Cardiology | Questions & Answers
13. A 60-year-old man presents to the emergency 1. Decreased left ventricular preload.
department complaining of dyspnea and weakness Rationale: This patient presents with cardiac tamponade. He is hypotensive, has
over the last 3 days. He has a history of upper muffled heart sounds, and increased jugular venous pressure, so the three
respiratory tract infection 3 weeks ago. His blood components of the Beck triad are present. The accumulated fluid in the
pressure is 87/55 mmHg and pulse is 120 beats/min. pericardial cavity will increase the intrapericardial pressure above the diastolic
Oxygen saturation is 95% on room air. Internal jugular ventricular pressure. This restricts venous return to the heart and lowers right
venous pressure is 11 cm H2O. Lungs are clear to and left ventricular filling. The net result is decreased preload, stroke volume,
auscultation. Heart sounds are muffled and distant. and cardiac output. Cardiac tamponade is caused by fluid accumulation in the
Which of the following is the most likely cause of the pericardial cavity that increases the intrapericardial pressure above the
patient's complaints? diastolic ventricular pressure. This restricts venous return to the heart and
1. Decreased left ventricular preload. lowers right and left ventricular filling. Cardiac tamponade will decrease the
2. Decreased cardiac contractility. compliance of the right ventricle, so during inspiration and because of
3. Increased right ventricular compliance. increased intrathoracic pressure and increased venous return the right ventricle
4. Absent radial pulse during inspiration. will shift the interventricular septum toward the left ventricle and reduce its
filling.
14. A 70-year-old woman presents to the emergency 4. Pericardial fluid accumulation.
department with sudden onset of syncope. She has Rationale: This patient most likely has cardiac tamponade. She is hypotensive,
hypertension. On exam, she is confused and agitated, her jugular veins are distended, and her heart sounds are muffled. Intraarterial
blood pressure is 90/50 mmHg and heart rate is 110 catheter in the radial artery shows pulsus paradoxus (more than 10 mmHg drop
beats/min. The jugular veins are distended. The lungs in the systolic blood pressure during inspiration), which is common in patients
are clear for auscultation. An intraarterial catheter in the with cardiac tamponade.
radial artery shows significant variation of systolic
blood pressure related to the respiratory cycle. Chest
x-ray shows widening of the mediastinum. Which of the
following is the most likely cause of the patient's
syncope?
1. Aortic stenosis.
2. Cardiac tachyarrhythmia.
3. Hypovolemia.
4. Pericardial fluid accumulation.
15. A 25-year-old male patient is brought to the 4. Cardiac tamponade.
emergency department after a motor vehicle accident. Rationale: This patient with low blood pressure, tachycardia, and distended
At the scene of the accident he was unresponsive and jugular veins after blunt thoracic trauma most likely has acute cardiac
intubated by paramedics. His blood pressure is 70/40 tamponade. Only 100 to 200 mL of fluid is sufficient to accumulate in the
mmHg and pulse is 120 beats/min. His pupils are equal pericardial cavity to compress the four cardiac chambers and compromise
and reactive to light. His neck veins are distended. both venous return and cardiac output. A chest x-ray could be normal because
There are multiple bruises involving the anterior chest of the small amount of fluid present.
and upper abdomen. His chest x-ray shows a small, left-
sided pleural effusion and normal cardiac contours.
Which of the following is the most likely diagnosis?
1. Aortic rupture.
2. Bronchial rupture.
3. Esophageal rupture.
4. Cardiac tamponade.
2. Which of the following are the main components of 4. Hypotension, muffled heart sounds, jugular venous distension.
the Beck triad in cardiac tamponade? Rationale: Beck's triad alerts clinicians that cardiac tamponade is potentially
1. Hypotension, electrical alternans, prominent x- present. The main components of cardiac tamponade are hypotension, muffled
descent in neck veins. heart sounds, and jugular venous distension. This triad is often associated with
2. Muffled heart sounds, friction rub, hypotension. prominent x-descent and absent y-descent and pulsus paradoxus. These
3. Jugular venous distension, Kussmaul sign, electrical features are caused by failure of ventricular filling and limited cardiac output.
alternans. The Kussmaul sign is seen in restrictive cardiomyopathy and constrictive
4. Hypotension, muffled heart sounds, jugular venous pericarditis. A friction rub can be seen in any condition associated with
distension. pericardial inflammation.
3. A 66-year-old man, known to have melanoma, 3. A greater than 10 mmHg drop in his systolic blood pressure with
presents to the emergency department with dizziness inspiration.
and shortness of breath for that last 3 days. On exam Rationale: This patient most likely has a developing cardiac tamponade from a
his blood pressure is 80/50 mmHg. He has muffled previously formed pericardial effusion. Melanoma is a known tumor to infiltrate
heart sounds and pedal edema. Chest x-ray revealed the pericardium. Cardiac tamponade is characterized by increased jugular
an enlarged cardiac silhouette. Which of the following venous pressure, muffled heart sounds, hypotension, and pulsus paradoxus
is most likely true of his physical exam? (greater than 10 mmHg drop in systolic blood pressure with inspiration). Answer
1. Clear lungs with decreased jugular venous pressure 1 is not correct because the JVP increases. A pericardial knock is more likely to
(JVP). be noted in constrictive pericarditis.
2. Increased JVP with inspiration.
3. A greater than 10 mmHg drop in his systolic blood
pressure with inspiration.
4. Pericardial knock.
4. A 70-year-old woman, known to have breast cancer, 3. Varied QRS complex from beat to beat.
presents to the emergency department with a sudden Rationale: This patient most likely has cardiac tamponade, which is
attack of syncope. On exam she is hypotensive, blood characterized by altered and varied QRS complexes from beat to beat caused
pressure (BP) is 75/50 mmHg, bilateral vesicular by the heart swinging in the accumulating fluid in the pericardial cavity.
breathing with no added sounds are heard on
auscultation of the chest, distant heart sounds, and
more than 10 mmHg drop of systolic BP with inspiration.
Which of the following findings is most probably seen
on electrocardiogram when requested?
1. Prolonged PR interval with dropped P-wave.
2. Widespread ST elevation.
3. Varied QRS complex from beat to beat.
4. Delta wave in almost all leads.
5. All of the following physical findings could be found 4. None of the above.
in cardiac tamponade, except: Rationale: Cardiac tamponade is associated with sinus tachycardia in almost all
1. Sinus bradycardia. cases, but sinus bradycardia could be found in subacute cardiac tamponade
2. Sinus tachycardia. associated with hypothyroidism. The Beck triad (hypotension, increased jugular
3. Increased jugular venous pressure. venous pressure, muffled heart sounds), pulsus paradoxus, and peripheral
4. None of the above. edema also are present in patients with cardiac tamponade.
, Adult-Gerontology Acute Care Nurse Practitioner Certification Review Cardiology | Questions & Answers
6. All of the following sentences are true about cardiac 3. Beck triad (hypotension, increased jugular venous pressure, muffled heart
tamponade, except: sounds) is present in almost all patients with cardiac tamponade.
1. Acute cardiac tamponade occurs within minutes and it Rationale: All the previous facts are true about cardiac tamponade except that
can be caused by trauma. the Beck triad, which consists of hypotension, elevated jugular venous
2. Subacute cardiac tamponade occurs within days to pressure, and muffled heart sounds, is present in only a minority of patients.
weeks and it can be caused by neoplasm.
3. Beck triad (hypotension, increased jugular venous
pressure, muffled heart sounds) is present in almost all
patients with cardiac tamponade.
4. Cardiomegaly associated with acute cardiac
tamponade is not usually seen on a chest x-ray until 200
mL fluid accumulates in the pericardial sac.
7. Which of the following drugs is involved in cardiac 4. Procainamide.
tamponade formation? Rationale: Drug-induced cardiac tamponade is rare. Procainamide, isoniazid,
1. Corticosteroids. and hydralazine (drug-induced lupus) are involved in cardiac tamponade
2. Ranitidine. formation. Others drugs found in drug-induced cardiac tamponade include
3. Amiodarone. dantrolene, anticoagulants, thrombolytics, phenytoin, penicillin, and
4. Procainamide. doxorubicin.
8. A 69-year-old man presents to the emergency 2. Urgent catheter pericardiocentesis.
department with a sudden attack of syncope. On exam, Rationale: This patient with suspected acute cardiac tamponade is
his blood pressure is 70/45 mmHg. He has muffled hemodynamically unstable. Both catheter pericardiocentesis and surgical
heart sounds, pulsus paradoxus, and peripheral edema. drainage of a pericardial effusion are highly effective at removal of pericardial
The chest x-ray reveals an enlarged cardiac silhouette. fluid. Catheter pericardiocentesis is the treatment of choice because it is less
He was diagnosed with lung cancer 3 years ago. Which invasive, less expensive, and does not need general anesthesia, which may
of the following is most correct management step for worsen the hemodynamic compromise if needle drainage is not performed
this patient? first to reduce the severity of the cardiac tamponade.
1. Giving streptokinase immediately.
2. Urgent catheter pericardiocentesis.
3. Percutaneous coronary intervention within minutes.
4. Immediate open cardiac surgery.
9. A 70-year-old man presented to the emergency 4. Immediate open cardiac surgery.
department with a sudden attack of syncope after Rationale: This patient with a previous history of diabetes mellitus, hypertension,
experiencing severe chest pain that radiated to his and long history of heavy smoking with presentation of sudden stabbing back
back. He described the pain as like being stabbed with pain, severe hypotension, muffled heart sounds, and increased jugular venous
a knife. He is known to have type 2 diabetes and pressure is most likely suffering from aortic dissection complicated by cardiac
hypertension. He has been a heavy smoker since he tamponade. Aortic dissection and myocardial rupture are contraindications for
was young. On exam, his blood pressure is 70/40 catheter pericardiocentesis because the relief of cardiac tamponade may lead
mmHg. He has muffled heart sounds, pulsus paradoxus, to more severe bleeding. Such patients require immediate surgical intervention.
and increased jugular venous pressure. Which of the
following is the most correct next step for the
management of this patient?
1. Giving streptokinase immediately.
2. Urgent catheter pericardiocentesis.
3. Percutaneous coronary intervention within minutes.
4. Immediate open cardiac surgery.
,Adult-Gerontology Acute Care Nurse Practitioner Certification Review Cardiology | Questions & Answers
10. A 32-year-old male patient developed viral 2. He is likely to demonstrate Kussmaul sign.
pericarditis 1 month ago. He was relatively Rationale: This patient with a history of acute pericarditis now presents with
asymptomatic and just complaining of mild chest pain. cardiac tamponade, which occurs in 15% of cases of acute pericarditis. He is
He was treated with ibuprofen as an outpatient. He now unlikely to have Kussmaul sign (increase un jugular venous pressure with
presents to the emergency department with new-onset inspiration) because this is usually seen in constrictive pericarditis. The other
dizziness and dyspnea. His blood pressure is 90/50 choices are true, and all can be found in cardiac tamponade.
mmHg. He has muffled heart sounds and elevated
jugular venous pressure. Which of the following
statements is false?
1. Echocardiogram is unlikely to show a thickened
pericardium.
2. He is likely to demonstrate Kussmaul sign.
3. His electrocardiogram is likely to show reduced
voltage or electrical alternans.
4. He is likely to have a pulsus paradoxus.
1. Which of the following is the most sensitive sign in 1. Drop in systolic blood pressure (BP) more than 10 mmHg during inspiration.
patients with cardiac tamponade? Rationale: Pulsus paradoxus (drop in systolic blood pressure [SBP] more than
1. Drop in systolic blood pressure (BP) more than 10 10 mmHg during inspiration) is the most sensitive sign in cardiac tamponade. A
mmHg during inspiration. drop in SBP more than 20 mmHg while changing the position of the patient is
2. Drop in systolic BP more than 20 mmHg during characteristic for orthostatic hypotension. Distant heart sounds can be found in
changing the position of the patient. cardiac tamponade, but it is not the most sensitive sign.
3. Distant heart sounds.
4. Absent radial pulse during inspiration.
12. A 72-year-old man presents to the emergency 4. Intravenous fluids.
department with a sudden attack of shortness of breath Rationale: This patient with cardiac tamponade is hemodynamically unstable
and dizziness. On exam his blood pressure is 75/35 and preload dependent. He should not be given diuretics, nitrates, or
mmHg. He has distant heart sounds, pulsus paradoxus, morphine because they could exacerbate his compromise. The patient should
and peripheral edema. Chest x-ray revealed an be supported with intravenous fluid while waiting for the pericardiocentesis to
enlarged cardiac silhouette. He was diagnosed with protect him from more deterioration.
lung cancer 5 years ago. While awaiting
pericardiocentesis, what does immediate supportive
care for this patient with cardiac tamponade include?
1. Diuresis with furosemide.
2. Nitrates to lower venous congestion.
3. Morphine to relieve dyspnea.
4. Intravenous fluids.
, Adult-Gerontology Acute Care Nurse Practitioner Certification Review Cardiology | Questions & Answers
13. A 60-year-old man presents to the emergency 1. Decreased left ventricular preload.
department complaining of dyspnea and weakness Rationale: This patient presents with cardiac tamponade. He is hypotensive, has
over the last 3 days. He has a history of upper muffled heart sounds, and increased jugular venous pressure, so the three
respiratory tract infection 3 weeks ago. His blood components of the Beck triad are present. The accumulated fluid in the
pressure is 87/55 mmHg and pulse is 120 beats/min. pericardial cavity will increase the intrapericardial pressure above the diastolic
Oxygen saturation is 95% on room air. Internal jugular ventricular pressure. This restricts venous return to the heart and lowers right
venous pressure is 11 cm H2O. Lungs are clear to and left ventricular filling. The net result is decreased preload, stroke volume,
auscultation. Heart sounds are muffled and distant. and cardiac output. Cardiac tamponade is caused by fluid accumulation in the
Which of the following is the most likely cause of the pericardial cavity that increases the intrapericardial pressure above the
patient's complaints? diastolic ventricular pressure. This restricts venous return to the heart and
1. Decreased left ventricular preload. lowers right and left ventricular filling. Cardiac tamponade will decrease the
2. Decreased cardiac contractility. compliance of the right ventricle, so during inspiration and because of
3. Increased right ventricular compliance. increased intrathoracic pressure and increased venous return the right ventricle
4. Absent radial pulse during inspiration. will shift the interventricular septum toward the left ventricle and reduce its
filling.
14. A 70-year-old woman presents to the emergency 4. Pericardial fluid accumulation.
department with sudden onset of syncope. She has Rationale: This patient most likely has cardiac tamponade. She is hypotensive,
hypertension. On exam, she is confused and agitated, her jugular veins are distended, and her heart sounds are muffled. Intraarterial
blood pressure is 90/50 mmHg and heart rate is 110 catheter in the radial artery shows pulsus paradoxus (more than 10 mmHg drop
beats/min. The jugular veins are distended. The lungs in the systolic blood pressure during inspiration), which is common in patients
are clear for auscultation. An intraarterial catheter in the with cardiac tamponade.
radial artery shows significant variation of systolic
blood pressure related to the respiratory cycle. Chest
x-ray shows widening of the mediastinum. Which of the
following is the most likely cause of the patient's
syncope?
1. Aortic stenosis.
2. Cardiac tachyarrhythmia.
3. Hypovolemia.
4. Pericardial fluid accumulation.
15. A 25-year-old male patient is brought to the 4. Cardiac tamponade.
emergency department after a motor vehicle accident. Rationale: This patient with low blood pressure, tachycardia, and distended
At the scene of the accident he was unresponsive and jugular veins after blunt thoracic trauma most likely has acute cardiac
intubated by paramedics. His blood pressure is 70/40 tamponade. Only 100 to 200 mL of fluid is sufficient to accumulate in the
mmHg and pulse is 120 beats/min. His pupils are equal pericardial cavity to compress the four cardiac chambers and compromise
and reactive to light. His neck veins are distended. both venous return and cardiac output. A chest x-ray could be normal because
There are multiple bruises involving the anterior chest of the small amount of fluid present.
and upper abdomen. His chest x-ray shows a small, left-
sided pleural effusion and normal cardiac contours.
Which of the following is the most likely diagnosis?
1. Aortic rupture.
2. Bronchial rupture.
3. Esophageal rupture.
4. Cardiac tamponade.
