Early Pericardiocentesis for Pericardial Effusion Post-Thrombolysis Using Narrow Blood Pressure Shock Index as a Diagnostic Indicator

Abstract

Emergency departments manage a wide range of life-threatening conditions that span both surgical and medical domains. Among these, acute cardiac emergencies require immediate and specialized intervention. Cardiac life support is crucial in such scenarios, and the integration of cardiac critical care into emergency settings has increasingly gained importance. Timely acute cardiac intensive care can be life-saving, especially in cases involving complications following myocardial infarction. One advanced technique that has become a focal point for emergency physicians in cardiac critical care is pericardiocentesis, particularly when performed under ultrasound guidance. This minimally invasive procedure, although technically demanding, has been employed with varying success rates in emergency departments. It plays a pivotal role in addressing pericardial effusion—a potentially fatal condition when it progresses to cardiac tamponade. Notably, pericardial tamponade is a rare, yet life-threatening complication of thrombolytic therapy used in the treatment of acute myocardial infarction (AMI). Therefore, early detection and prompt management are essential to avert serious consequences. A key tool in the early identification of hemodynamic instability is the Blood Pressure Shock Index (BPSI), defined as the ratio of heart rate to systolic blood pressure. A narrow BPSI serves as a sensitive early indicator of impending circulatory collapse. This report highlights a clinical case where the identification of a narrow BPSI led to timely pericardiocentesis, ultimately resulting in the successful management of a pericardial effusion that developed post-thrombolysis. This case underscores the value of combining clinical acumen with diagnostic tools to guide lifesaving interventions in emergency care.