Cardiac tamponade

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 20 Aug 2025

Last updated: 02 Apr 2025

Cardiac tamponade is a medical emergency.

May be a complication of any disorder that results in pericardial effusion. In people from endemic regions, tuberculosis pericarditis remains a prominent cause of pericardial effusion and tamponade.

Presenting symptoms range from mild dyspnea and atypical chest pain to cardiogenic shock. Clinical signs include: tachycardia, hypotension, distant heart sounds, elevated jugular venous pressure, and a pulsus paradoxus (>10 mmHg variation in systolic blood pressure with inspiration).

Echocardiography is essential for evaluation.

Rapidly fatal if not promptly drained through needle pericardiocentesis or surgical drainage of the pericardium.

Definição

Cardiac tamponade, also known as pericardial tamponade, is the accumulation of pericardial fluid, blood, pus, or air within the pericardial space (pericardial effusion) that causes an increase in intrapericardial pressure, restricting cardiac filling and decreasing cardiac output. It is a medical emergency and can be rapidly fatal if it is not promptly diagnosed and treated.[1] The diagnosis of cardiac tamponade is based on clinical suspicion and supported by evidence of hemodynamic compromise on echocardiography.[2]

See Evaluation of pericardial effusion.

História e exame físico

Principais fatores diagnósticos

malignancy
presence of other risk factors
dyspnea
elevated jugular venous pressure (JVP)
distant heart sounds
pulsus paradoxus
hypotension
tachycardia
recent cardiac surgery or intervention
Beck triad: hypotension, distant heart sounds, and elevated JVP

Detalhes completos

Outros fatores diagnósticos

chest pain
abdominal pain
fever
pericardial rub

Detalhes completos

Fatores de risco

malignancy
aortic dissection
purulent pericarditis
large idiopathic chronic pericardial effusion
post-cardiac surgery or intervention
tuberculosis (TB)
autoimmune disease
hypothyroidism
end-stage renal failure
anticoagulation

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

ECG
transthoracic echocardiogram
CXR
CBC
erythrocyte sedimentation rate/CRP
cardiac enzymes

Detalhes completos

Investigações a serem consideradas

cardiac CT
cardiac MRI
cardiac catheterization
pericardiocentesis fluid for culture and cytology

Detalhes completos

Algoritmo de tratamento

AGUDA

without hemopericardium, trauma, or purulent effusion

with hemopericardium, trauma, or purulent effusion

Colaboradores

Autores

Antonio Abbate, MD, PhD

Ruth C. Heede Professor of Cardiovascular Medicine

Division of Cardiovascular Medicine

Berne Cardiovascular Research Center

University of Virginia School of Medicine

Charlottesville

Declarações

AA has received consultant fees from Kiniksa Pharmaceuticals. He is an author of references cited in this topic.

Agradecimentos

Dr Antonio Abbate would like to gratefully acknowledge Dr Vaikom S. Mahadevan, Dr Harsh Agrawal, Dr Jonathan Bella, Dr Liran Blum, and Dr Michael Spinelli, previous contributors to this topic.

Disclosures

VSM declares that he is a proctor for Edwards Lifesciences for transcatheter valves and also a proctor for Abbott for closure devices. HA, JB, LB, and MS declare that they have no competing interests.

Peer reviewers

Ramon Castello, MD

Professor of Medicine

Director of Echocardiography

Mayo Clinic

Jacksonville

Disclosures

RC declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Klein AL, Abbara S, Agler DA, et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr. 2013 Sep;26(9):965-1012.Full text Abstract

Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases. Eur Heart J. 2015 Nov 7;36(42):2921-64.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Constrictive pericarditis
- Restrictive cardiomyopathy
- Cardiogenic shock
More Differentials
Guidelines
- 2015 ESC guidelines on the diagnosis and management of pericardial diseases
- American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease
More Guidelines
Patient information
Heart attack
Heart failure
More Patient information
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Cardiac tamponade

Summary

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

without hemopericardium, trauma, or purulent effusion

with hemopericardium, trauma, or purulent effusion

Colaboradores

Autores

Antonio Abbate, MD, PhD

Declarações

Agradecimentos

Disclosures

Peer reviewers

Ramon Castello, MD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice