When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Cardiac tamponade

Last reviewed: 23 Jun 2024
Last updated: 16 Dec 2022

Summary

Definition

History and exam

Key diagnostic factors

  • malignancy
  • presence of other risk factors
  • dyspnea
  • 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 hemorrhage
  • tuberculosis (TB)
  • autoimmune disease
  • hypothyroidism
  • uremia and renal failure
  • anticoagulation
Full details

Diagnostic tests

1st tests to order

  • ECG
  • transthoracic echocardiogram
  • CXR
  • CBC
  • erythrocyte sedimentation rate
  • cardiac enzymes
Full details

Tests to consider

  • cardiac catheterization
  • pericardiocentesis fluid for culture and cytology
Full details

Treatment algorithm

ACUTE

hemodynamically stable/pretamponade: systolic BP >110 mmHg, with pulsus paradoxus <10 mmHg

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

Contributors

Authors

Vaikom S. Mahadevan, MD

Professor of Medicine

Division of Cardiology

University of California

San Francisco

CA

Disclosures

VSM declares that he is a proctor for Edwards Lifesciences for transcatheter valves and also a proctor for Abbott for closure devices.

Harsh Agrawal, MD

Fellow in Structural Cardiac Intervention

University of California

San Francisco

CA

Disclosures

HA declares that he has no competing interests.

Acknowledgements

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

Disclosures

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

FL

Disclosures

RC declares that he has no competing interests.

  • Differentials

    • Constrictive pericarditis
    • Restrictive cardiomyopathy
    • Cardiogenic shock
    More Differentials
  • Guidelines

    • Guidelines on the diagnosis and management of pericardial diseases
    • Guidelines on the diagnosis and management of pericardial diseases
    More Guidelines
  • Patient information

    Heart attack

    Heart failure

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer