Cardiac tamponade
Cardiac tamponade is life-threatening compression of the heart by a pericardial effusion, impairing diastolic filling and cardiac output. It presents with hypotension, distended neck veins, and pulsus paradoxus, is confirmed by echocardiography, and is treated by urgent pericardiocentesis; avoid vasodilators and aggressive diuresis.
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What this article covers
- Overview
Definition: cardiac tamponade is hemodynamically significant compression of the heart by a pericardial effusion, raising intrapericardial pressure and impairing diastolic filling.
- Epidemiology
A feared complication of pericardial effusion of any cause.
- Risk factors
Any pericardial effusion, especially rapidly accumulating ones.
- Pathophysiology
Raised intrapericardial pressure: effusion pressure exceeds cardiac chamber diastolic pressure, compressing the chambers.
- Clinical features
Dyspnea, tachycardia, and hypotension. Distended neck veins with a prominent x descent and muffled heart sounds (Beck triad).
- Differential diagnosis
Tension pneumothorax: obstructive shock with absent breath sounds and tracheal shift, without a pericardial effusion.
- Diagnosis
Establish clinically and confirm with echocardiography showing an effusion with tamponade physiology: the diagnostic basis is the clinical picture (hypotension, elevated venous pressure, pulsus…
- Management
First-line, drain the pericardium urgently: perform echocardiography-guided pericardiocentesis (or surgical drainage) to relieve the compression, the definitive treatment.
- Complications
Cardiac arrest and death without drainage.
- Prognosis
Excellent immediate recovery after drainage.
- Prevention
Prompt recognition and drainage of significant effusions.
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Related articles
- Pericardial effusion
Pericardial effusion is accumulation of fluid in the pericardial space, ranging from an incidental finding to life-threatening tamponade. Its hemodynamic effect depends on the rate of accumulation rather than volume alone, and management ranges from observation and treating the cause to pericardiocentesis for tamponade or large symptomatic effusions.
- Acute pericarditis
Acute pericarditis is inflammation of the pericardium, most often viral or idiopathic, presenting with pleuritic chest pain relieved by sitting forward, a pericardial friction rub, and diffuse ST elevation with PR depression. Treatment is an NSAID plus colchicine, and the main hazards are effusion, tamponade, and recurrence.
- Constrictive pericarditis
Constrictive pericarditis is a rigid, often calcified pericardium that impairs diastolic filling, causing predominantly right-sided heart failure. It follows pericardial injury (post-surgical, tuberculous, radiation, or idiopathic), is distinguished from restrictive cardiomyopathy by hemodynamic and imaging features, and definitive treatment is pericardiectomy.
- Restrictive cardiomyopathy
Restrictive cardiomyopathy is impaired ventricular filling from a stiff, noncompliant myocardium with preserved (or near-preserved) systolic function and non-dilated ventricles, most often from infiltration such as amyloidosis. It presents as predominantly right-sided heart failure, and diagnosis centers on echocardiography and cardiac MRI plus a search for the underlying cause, distinguishing it from constrictive pericarditis; management treats the underlying cause with cautious diuresis.
- Cardiogenic shock
Cardiogenic shock is primary cardiac pump failure that produces sustained hypotension and end-organ hypoperfusion despite adequate filling, most often from a large acute myocardial infarction. Survival depends on emergently reversing the cause, usually by revascularization, while supporting perfusion with vasopressors, inotropes, and, when refractory, mechanical circulatory support.
- Acute heart failure
Acute heart failure is the rapid onset or worsening of heart failure symptoms requiring urgent therapy, most often pulmonary congestion from a precipitant such as ischemia, arrhythmia, or nonadherence. Management is oxygen, intravenous diuretics, and vasodilators for the congested-but-perfused patient, with inotropes or support for the hypoperfused patient.