Last reviewed: 7 Apr 2021
Last updated: 13 Mar 2019



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

Other diagnostic factors

  • chest pain
  • abdominal pain
  • confusion
  • fever
  • pericardial rub

Risk factors

  • malignancy
  • aortic dissection
  • purulent pericarditis
  • large idiopathic pericardial effusion
  • iatrogenic-related hemorrhage
  • tuberculosis (TB)
  • autoimmune disease
  • hypothyroidism
  • uremia
  • anticoagulation

Diagnostic investigations

1st investigations to order

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

Investigations to consider

  • cardiac catheterization
  • pericardiocentesis fluid for culture and cytology

Treatment algorithm


Professor of Medicine

Division of Cardiology

University of California

San Francisco



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

Fellow in Structural Cardiac Intervention

University of California

San Francisco



HA declares that he has no competing interests.

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.


JB, LB, and MS declare that they have no competing interests.

Peer reviewersVIEW ALL

Professor of Medicine

Director of Echocardiography

Mayo Clinic




RC declares that he has no competing interests.

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