Management
Once the diagnosis of tamponade is confirmed, immediate drainage should be considered.1 Optimal medical care, including volume expansion, the avoidance of diuretics or vasodilators, and inotropic support, if the patient is hypotensive, is paramount in the acute settings. Volume expansion has been proposed as an alternative; however, the scientific evidence for this recommendation is not widely approved by many institutions in the settings of cardiac tamponade due to poor evidence in practical settings13. In fact, excessive fluid administration can impede chambers dynamics with additive forces to an already suffering pericardium.17 It appears that patients with baseline systolic arterial blood pressure <100 mmHg could benefit from rapid saline infusion to ensure hemodynamic stabilization awaiting pericardiocentesis, the definitive method of management. The watchful and brief use of inotropes is relatively controversial, where a higher resistance in the peripheral circulation is already established in the context of sympathetic overdrive, a condition where known inotropic agents adding arrythmogenicity
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