Imaging confirms pericardial effusion with tamponade?

• A. Echocardiography shows pericardial effusion with diastolic RV collapse
• B. ST elevations
• C. Hyperkalemia
• D. Normal imaging

Answer: (A)

The key idea is that tamponade is about impaired filling due to pressure from fluid around the heart, which shows up on imaging as diastolic collapse of the right ventricle when there is a pericardial effusion. In tamponade, the intrapericardial pressure approaches or exceeds the filling pressures of the right heart, especially during diastole, causing the right ventricle to collapse. This echo finding—diastolic RV collapse in the setting of a pericardial effusion—is the hallmark that distinguishes tamponade physiology from a simple effusion.

Having pericardial fluid alone doesn’t confirm tamponade; you need evidence that filling is compromised. Other choices don’t fit because ST elevations point to myocardial injury or pericarditis, not specifically tamponade; hyperkalemia is an electrolyte issue with conduction effects, not an imaging finding of tamponade; normal imaging would not align with a tamponade diagnosis.

In practice, seeing diastolic RV collapse on echocardiography with a pericardial effusion indicates the need for urgent intervention to relieve the pressure and restore cardiac filling.