Ask the Clinical Instructor

I went to the hospital on my regular clinical day to find a team already there. They said they had been called in for an emergency for a patient early in the morning. My mentor said that the patient presented with Beck’s triad. I was wondering if you could tell me what this is and why it is important. That is a good question. Beck’s triad, as its name implies, is a grouping of three signs which are hypotension, JVD (jugular venous distension) and muffled heart sounds. Since I was not there, I would have to make an educated guess, but this patient probably was experiencing an episode of acute cardiac tamponade. What are some of the causes of acute cardiac tamponade? Bacterial infection, the Coxsackie B virus, perforation of an interventional wire and chest trauma are a few possible causes. Tamponade means that the heart is surrounded by fluid (which creates the muffled heart sounds), making it very difficult for the right heart to properly fill (causing the JVD). The right ventricle not filling will also cause hypotension. If the right ventricle can't fill properly, then the left ventricle can't fill well, causing decreased cardiac output and decreased stroke volume, which results in hypotension. Treatment is a pericardiocentesis. This procedure involves a needle being inserted into the pericardium to drain the excess fluid, which in turn, hopefully, will make the patient feel better. When I see the technologist injecting the contrast, I see a swirl of black to the opposite side of the catheter. Is this contrast too? You are right, this is contrast. This contrast, instead of flowing through the coronary, is swirling in the Sinus of Valsalva. During systole, the contrast is pushed up the ascending aorta. Contact Jason Wilson with your questions at WilsonJD@EllisHospital.org

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