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Cardiac tamponade is a life-threatening emergency caused by fluid accumulation in the pericardial space that compresses the heart and impairs venous return. This condition prevents adequate cardiac filling during diastole, leading to severe hemodynamic compromise and potential cardiovascular collapse if not promptly treated.
Pericardial fluid accumulation creates external pressure on the heart that exceeds normal filling pressures, causing equalization of diastolic pressures across all cardiac chambers. The rigid pericardial sac cannot accommodate rapid fluid accumulation, leading to impaired ventricular filling, reduced stroke volume, and compensatory tachycardia as the body attempts to maintain cardiac output.
Recognition relies on Beck's triad (elevated JVP, hypotension, muffled heart sounds) though this classic presentation occurs in only 10% of cases. Pulsus paradoxus >20mmHg is highly sensitive, and echocardiography showing diastolic collapse of right-sided chambers confirms the diagnosis and guides urgent pericardiocentesis or surgical intervention.
Key imaging focus: Pericardial effusion, RV diastolic collapse, IVC plethora, respiratory variation