Parasternal Long Axis: Right ventricular diastolic collapse, the most specific finding for echocardiographic tamponade.
Parasternal short axis: right ventricular diastolic collapse.
Apical 4 chamber: diastolic RV collapse.
IVC is plethoric, the most sensitive finding for echocardiographic tamponade.
An elderly patient with a history of lung cancer presented with hypotension and undifferentiated dyspnea. A point-of-care ultrasound (POCUS) echo was performed to assess for right ventricular strain before proceeding to a CT scan for suspected pulmonary embolism (PE). Instead of finding massive PE, POCUS revealed tamponade physiology. The patient underwent an urgent pericardiocentesis, with more than a liter of fluid drained, leading to a dramatic improvement.
Take-home points:
Senior Residents: Would always advocate for a POCUS echo in cases of undifferentiated dyspnea or hypotension. It can be life-saving. Strive to be the expert in the room to diagnose tamponade. Findings: most sensitive is a plethoric IVC, most specific is diastolic RV collapse, earliest is RA systolic collapse. Here’s a nice review: What echocardiographic findings suggest a pericardial effusion is causing tamponade?
Junior Residents: Start integrating this skill into your practice now. You'll be grateful for it when it counts.