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cardio.cardiac-tamponade.core.v1

Cardiac tamponade

cardiologyacuteadultacuteinpatient
Start encounter →Print handoutPRODUCTION

Depth-pass 2026-05-14 (shard-06-cardio-acute): regimen ladder expanded from 3 → 6 etiology-aware steps (bridge → definitive drainage → etiology-directed colchicine/NSAID → malignant pericardial window → uremic dialysis intensification → post-procedural / hemopericardium); setting playbooks expanded from 2 → 5 (ed / icu / inpatient post-drainage / transition pericarditis-clinic handoff / outpatient long-term surveillance); calculators expanded from 1 → 3 band-mapped (calc.map / calc.ckd_epi_2021 / calc.qsofa); evidence.pmids expanded from 4 → 14 (added ESC 2015 26320112, Roy 17456823, ICAP 23992557, CORP 21873705, CORP-2 24694983, Imazio colchicine meta-analysis 22442198, AIRTRIP 27825009, RHAPSODY 33200890, Khandaker 20511488, Sagristà-Sauleda 14749455 + 4 sibling-routing anchors). Co-located _design-brief.md and _research-bundle.md authored under src/lib/dossiers/ (per shard-06-cardio-acute pattern, not under tier3/problem-package — design_brief field updated accordingly). IL-1 blockade (anakinra AIRTRIP / rilonacept RHAPSODY) referenced in evidence + setting_playbooks.outpatient escalation triggers, but ownership delegated to chronic pericarditis engine cardio.pericarditis.core.v1 — no IL-1 RxCUIs added to regimen drugs[]. last_reconciled bumped 2026-04-13 → 2026-05-14; ESC 2015 (PMID 26320112) confirmed as current per memory/reference_verified_current_guidelines_2026_04_10.md (no ESC 2026 pericardial update issued). Six severity triggers retained (hemodynamic instability, hemorrhagic tamponade, malignant effusion, recurrent post-drainage, effusive-constrictive, uremic pericarditis); RxNav validation of 8 RxCUIs flagged for next-session run per memory/project_rxnav_validator_shipped.md.

Entry points (4)

  • symptom
    Dyspnea + hypotension + JVD (Beck triad; Spodick Circulation 2003)
    dyspnea_with_hypotension
  • imaging
    Echo: pericardial effusion + RV diastolic collapse / IVC plethora (ESC 2015 §Tamponade Diagnosis)
    echo_pericardial_effusion
  • symptom
    Pulsus paradoxus >10 mmHg (Roy JAMA 2007; Spodick Circulation 2003)
    pulsus_paradoxus
  • problem_list
    Recent pericarditis / malignancy / post-cardiac surgery / trauma (Ristić EHJ 2014)
    recent_pericardial_disease

Required inputs (8)

  • agerequired
    demographic • used at CONTEXT
    Etiology distribution (malignant vs idiopathic vs uremic; Ristić EHJ 2014 triage classification)
  • sbprequired
    vital • used at RED_FLAGS
    Hypotension is part of Beck triad; pulsus paradoxus measurement (Spodick Circulation 2003)
  • hrrequired
    vital • used at CONTEXT
    Compensatory tachycardia (ESC 2015 §Clinical Presentation)
  • echorequired
    imaging • used at INITIAL_WORKUP
    Definitive bedside dx — chamber collapse, IVC, swinging heart (ESC 2015 Class I, Recommendation)
  • malignancy
    history • used at CONTEXT
    Malignant effusion = top etiology in oncology pts (Ristić EHJ 2014)
  • recent_cardiac_procedure
    history • used at CONTEXT
    Post-PCI/ablation/surgery tamponade (ESC 2015 §Iatrogenic Tamponade)
  • pericarditis_history
    history • used at CONTEXT
    Acute or recurrent pericarditis precedent (Adler et al 2015)
  • anticoagulation
    history • used at CONTEXT
    AC + post-procedure raises hemorrhagic tamponade risk (ESC 2015 §Iatrogenic Tamponade)

12-phase flow (9)

  1. 1FRAME
    Time-critical decompensation — pericardiocentesis is curative (ESC 2015 Class I)
    inputs: sbp
    advance: tamponade physiology suspected
  2. 2ENTRY
    Recognize Beck triad + recent precedent (Spodick Circulation 2003)
    inputs: age
    advance: high-suspicion presentation
  3. 3CONTEXT
    Assess etiology (malignancy / post-procedure / pericarditis / trauma / uremia / autoimmune; Ristić EHJ 2014 triage)
    inputs: malignancy, recent_cardiac_procedure, pericarditis_history, anticoagulation
    advance: etiology context captured
  4. 4RED_FLAGS
    Obstructive shock physiology — hypotension, hypoperfusion, pre-arrest (ESC 2015 §Tamponade Management)
    inputs: sbp, hr
    advance: shock recognized → pericardiocentesis prepared
  5. 5INITIAL_WORKUP
    STAT echo (TTE), ECG (electrical alternans, low voltage), CXR, troponin, BMP, coags (ESC 2015 Class I; Roy JAMA 2007)
    inputs: echo
    actions: panel.cardiac, panel.coag
    advance: echo confirms tamponade physiology
  6. 6DIFFERENTIAL
    Effusive vs effusive-constrictive vs constrictive; etiology subtyping (Adler et al 2015 Table 4)
    advance: physiology + etiology classified
  7. 7TREATMENT
    Pericardiocentesis (echo-guided preferred; ESC 2015 Class I); pericardial window for recurrent or post-surgical; AVOID positive-pressure ventilation pre-drain; IV fluids as bridge
    inputs: sbp
    advance: pericardial fluid drained or surgical window planned
  8. 8DISPOSITION
    CCU/ICU post-drain; cardiothoracic if surgical; oncology consult for malignant (Ristić EHJ 2014)
    advance: disposition assigned
  9. 9MONITORING
    Re-accumulation surveillance (echo q12–24h initially; ESC 2015 §Follow-up); fluid analysis (cytology, culture, AFB, ADA, cell count)
    actions: panel.pleural
    advance: fluid analysis pending and follow-up scheduled