Cardiac tamponade
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
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 and renal failure
- anticoagulation
Diagnostic tests
1st tests to order
- ECG
- transthoracic echocardiogram
- CXR
- CBC
- erythrocyte sedimentation rate
- cardiac enzymes
Tests to consider
- cardiac catheterization
- pericardiocentesis fluid for culture and cytology
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
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.
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
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.e15.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
Little WC, Freeman GL. Pericardial disease. Circulation. 2006 Mar 28;113(12):1622-32.Full text Abstract
Soler-Soler J, Sagristà-Sauleda J, Permanyer-Miralda G., et al. Management of pericardial effusion. Heart. 2001;86:235-240. 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 DifferentialsGuidelines
- Guidelines on the diagnosis and management of pericardial diseases
- Guidelines on the diagnosis and management of pericardial diseases
More GuidelinesPatient information
Heart attack
Heart failure
More Patient information
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