Which of the following are symptoms commonly seen with pericardial effusion?

• A. Distended neck veins, hypotension, tachypnea, pulsus paradoxus
• B. Chest pain with radiation to the left arm only
• C. Cough and fever without hemodynamic changes
• D. Seizures and syncope unrelated to heart

Answer: (A)

The key idea is recognizing how a significant pericardial effusion can cause cardiac tamponade, where the fluid in the pericardial sac compresses the heart and impairs filling. This leads to reduced cardiac output and hypotension. Distended neck veins come from elevated right atrial pressure as venous return backs up. Pulsus paradoxus—an exaggerated drop in systolic blood pressure during inspiration—occurs because the expanding right ventricle during inspiration further restricts left ventricular filling in the rigid pericardial sac. Tachypnea appears from dyspnea and respiratory effort as the body tries to compensate for reduced oxygen delivery. Put together, these signs describe tamponade physiology, which is the classic presentation of symptomatic pericardial effusion.

The other options don’t fit as well: chest pain with radiation to the left arm points to myocardial ischemia; cough and fever without hemodynamic changes suggests infection or inflammatory or respiratory processes without tamponade; seizures and syncope without context isn’t the typical presentation of pericardial effusion unless tamponade develops, and even then the combination of JVD, hypotension, and pulsus paradoxus is the hallmark.