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: 4 Sep 2023
Last updated: 16 Dec 2022



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
More key diagnostic factors

Other diagnostic factors

  • chest pain
  • abdominal pain
  • confusion
  • fever
  • pericardial rub
Other diagnostic factors

Risk factors

  • malignancy
  • aortic dissection
  • purulent pericarditis
  • large idiopathic pericardial effusion
  • iatrogenic-related hemorrhage
  • tuberculosis (TB)
  • autoimmune disease
  • hypothyroidism
  • uremia and renal failure
  • anticoagulation
More risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • transthoracic echocardiogram
  • CXR
  • CBC
  • erythrocyte sedimentation rate
  • cardiac enzymes
More 1st investigations to order

Investigations to consider

  • cardiac catheterization
  • pericardiocentesis fluid for culture and cytology
More investigations to consider

Treatment algorithm


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

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



Vaikom S. Mahadevan, MD

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.

Harsh Agrawal, MD

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 reviewers

Ramon Castello, MD

Professor of Medicine

Director of Echocardiography

Mayo Clinic




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 leaflets

    Heart attack

    Heart failure

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

Use of this content is subject to our disclaimer