Beck's triad — hypotension, distant heart sounds, and JVD — with pulsus paradoxus >10 mm Hg in a post-MI patient is cardiac tamponade. Tamponade is obstructive shock from fluid in the pericardial space compressing the heart and limiting diastolic filling. Priority: notify provider, prepare for emergent pericardiocentesis (definitive treatment), and bridge with IV fluid bolus to increase preload and oxygen support. Diuretics (choice 1) drop preload and worsen tamponade. Supine intubation (choice 2) without decompression worsens hemodynamics. Beta-blockers (choice 4) drop HR and CO and are contraindicated.
In-depth explanation
Cardiac tamponade is obstructive shock from fluid in the pericardial space compressing the heart, limiting diastolic filling, and reducing cardiac output. Common causes are pericarditis, post-MI free wall rupture or Dressler syndrome, malignancy, trauma, and post-cardiac surgery. Hallmarks are Beck's triad (hypotension, distant heart sounds, JVD) plus pulsus paradoxus greater than 10 mm Hg. Pulsus paradoxus is a drop in systolic BP greater than 10 mm Hg during inspiration, detected by sphygmomanometer or arterial line, and is specific for diseases that exaggerate the normal inspiratory drop in left ventricular filling: tamponade, severe asthma, COPD exacerbation, and tension pneumothorax. Pericardiocentesis is the emergent percutaneous drainage of pericardial fluid via the subxiphoid or apical approach under echocardiographic or fluoroscopic guidance and is the definitive treatment; surgical window or drainage may follow if recurrent.
For study reference only. Always follow current clinical guidelines and your institution’s protocols.