Subacute pericardial tamponade presenting with hypertension

Pericardial tamponade is a potentially fatal condition requiring urgent intervention. A 64-year-old lady presented to the emergency department with abdominal pain and syncope, with noted subxiphoid tenderness and peripheral oedema.

The patient was hypertensive at presentation and developed respiratory distress and anuria.

Bedside echocardiography revealed a 6cm pericardial effusion with right ventricular diastolic collapse and urgent pericardiocentesis drained 1800mls within 24hrs. Clinical features can be variable and patients can present with hypertension prior to cardiovascular collapse.

Tamponade diagnosis is dependent on urgent echocardiography, which is increasingly adopted among ICU doctors.