Clinical Disease

cardiac

High-impact pattern

Cardiac Tamponade — Perioperative Recognition and Crisis Response

Acute pericardial compression of cardiac filling causing obstructive shock; high-yield in aortic emergencies, line placement, and thoracic surgery

Cardiac tamponade is acute pericardial accumulation that restricts ventricular filling and produces obstructive shock; anesthesia-relevant causes include Type A aortic dissection or intramural hematoma, iatrogenic atrial injury from central lines, and post-thoracic-surgery mediastinal shift.

If you forget

HEADLINE: Beck's triad is unreliable — TRUST pulsus paradoxus and TEE

Board trap

Classic trap: induction in unrecognized tamponade. The patient is preload-dependent; propofol, IPPV, and tachycardia with poor diastolic time all collapse venous return — decompress first or have scalpel in hand at induction.

Key numbers

SBP fall >10 mmHg on inspiration = pulsus paradoxus threshold
Even 50-100 mL of acute pericardial fluid can produce tamponade physiology
Pericardiocentesis needle: 16-18G from subxiphoid, 30-45° toward left shoulder
Type A IMH: pericardial effusion on admission is a high-risk imaging feature
Uncuffed dialysis catheter tip in the heart → atrial perforation and tamponade risk

Reviewed Sep 24, 2026 for clinical accuracy by BoardsBridge Editorial Process

Uri Rozen, MD — Licensed Physician, Israel

Source guidelines: ACC AHA Aortic Disease 2022 · ACC AHA Aortic Disease 2022 · ACC AHA Aortic Disease 2022 · KDIGO AKI 2012

Re-review cadence: 12 months from reviewed date.

Drill this as a SOE stem →

Related on BoardsBridge

Card ID: tamponade · Path: aba.cardiac.great-vessels-and-pericardium.tamponade