A 40-year-old woman presents with hypotension, raised JVP and muffled heart sounds after a stab injury to the chest. Transthoracic echocardiography is performed. Which combination of findings confirms cardiac tamponade?
- A Diastolic collapse of the right ventricular free wall and a plethodic non-collapsing inferior vena cava ✓
- B Left ventricular hypertrophy with reduced ejection fraction and dilated left atrium
- C Systolic anterior motion of the mitral valve with dynamic left ventricular outflow tract obstruction
- D Dilated right ventricle with septal flattening in systole
Correct answer: A. Diastolic collapse of the right ventricular free wall and a plethodic non-collapsing inferior vena cava
Explanation
Tamponade produces pericardial fluid under pressure, causing diastolic collapse of the right ventricular free wall (earliest and most specific sign) and right atrial inversion, plus a dilated IVC that fails to collapse with inspiration. Option D describes acute pulmonary embolism physiology, a key differential in shock, and option B describes chronic heart failure. Recognising tamponade on echo mandates immediate pericardiocentesis.
Reference: Feigenbaum's Echocardiography, 8th ed.
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