Cardiac tamponade

Last reviewed: April 2018

Last updated: November 2017

Summary

Medical emergency; can be rapidly fatal if not promptly drained through needle pericardiocentesis or surgical drainage of the pericardium.

Clinical signs include tachycardia, hypotension, distant heart sounds, elevated jugular venous pressure, and a pulsus paradoxus >10 mmHg.

Echocardiography is essential for evaluation.

May be caused by any disorder that results in pericardial effusion.

Pericardiocentesis may be complicated by puncture or laceration of the coronary, internal mammary, or pericardial blood vessels.

Definition

Cardiac tamponade is the accumulation of pericardial fluid, blood, pus, or air within the pericardial space that creates an increase in intra-pericardial pressure, restricting cardiac filling and decreasing cardiac output. Cardiac tamponade is a cardiac emergency and can be fatal if it is not quickly diagnosed and treated promptly. [1] The diagnosis is based on clinical suspicion and supported by evidence of haemodynamic compromise on echocardiography.

History and exam

Key diagnostic factors

malignancy
presence of other risk factors
dyspnoea
elevated jugular venous pressure
distant heart sounds
pulsus paradoxus
hypotension
tachycardia
recent invasive cardiac intervention procedure

Full details

Other diagnostic factors

chest pain
abdominal pain
confusion
fever
pericardial rub

Full details

Risk factors

malignancy
aortic dissection
purulent pericarditis
large idiopathic pericardial effusion
iatrogenic-related haemorrhage
tuberculosis
autoimmune disease
hypothyroidism
uraemia
anticoagulation

Full details

Diagnostic investigations

1st investigations to order

ECG
transthoracic echocardiogram
CXR
FBC
ESR
cardiac enzymes

Full details

Investigations to consider

cardiac catheterisation
pericardiocentesis fluid for culture and cytology

Full details

Treatment algorithm

ACUTE

haemodynamically stable/pre-tamponade: systolic BP >110 mmHg, with pulsus paradoxus <10 mmHg

haemodynamic instability/tamponade: systolic BP <110 mmHg, pulsus paradoxus of >10 mmHg

Contributors

Authors VIEW ALL 

Jonathan Bella, MD

Chief

Division of Cardiology

Bronx-Lebanon Hospital Center

Bronx

Disclosures

JB declares that he has no competing interests.

Acknowledgements

Dr Jonathan Bella would like to gratefully acknowledge Dr Liran Blum and Dr Michael Spinelli, previous contributors to this monograph. LB and MS declare that they have no competing interests.

Peer reviewers VIEW ALL 

Vaikom Mahadevan, MD

Professor of Medicine

Division of Cardiology

University of California

San Francisco

Disclosures

VM declares that he has no competing interests.

Ramon Castello, MD

Professor of Medicine

Director of Echocardiography

Mayo Clinic

Jacksonville

Disclosures

RC declares that he has no competing interests.

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Cardiac tamponade

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

haemodynamically stable/pre-tamponade: systolic BP >110 mmHg, with pulsus paradoxus <10 mmHg

haemodynamic instability/tamponade: systolic BP <110 mmHg, pulsus paradoxus of >10 mmHg

Contributors

Authors VIEW ALL 

Jonathan Bella, MD

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

Vaikom Mahadevan, MD

Disclosures

Ramon Castello, MD

Disclosures

Differentials

Guidelines

Patient leaflets

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