Management of Cardiac Tamponade

  • David D. Berg
  • Gregory W. Barsness
  • Benjamin A. OlenchockEmail author


Cardiac tamponade is a cardiovascular emergency that occurs when fluid accumulates in the intrapericardial space and impairs cardiac filling. Prompt recognition and diagnosis of cardiac tamponade using physical exam and bedside echocardiography is critical. Emergent drainage of the pericardial effusion by percutaneous needle pericardiocentesis is the mainstay of tamponade management. In certain cases, surgical drainage may be required. In this chapter, we review the pathophysiology and management of acute cardiac tamponade.


Cardiac tamponade Echocardiography Pericardial effusion Pericardiocentesis Pulsus paradoxus Shock Effusive-constrictive pericarditis 

Supplementary material

Video 14.1

Transthoracic echocardiogram, subxiphoid view, demonstrating large circumferential pericardial effusion with RV diastolic collapse (AVI 7120 kb)


  1. 1.
    Sagrista-Sauleda J, Angel J, Sambola A, Permanyer-Miralda G. Hemodynamic effects of volume expansion in patients with cardiac tamponade. Circulation. 2008;117(12):1545–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Little WC, Freeman GL. Pericardial disease. Circulation. 2006;113(12):1622–32.CrossRefPubMedGoogle Scholar
  3. 3.
    Reddy PS, Curtiss EI, Uretsky BF. Spectrum of hemodynamic changes in cardiac tamponade. Am J Cardiol. 1990;66(20):1487–91.CrossRefPubMedGoogle Scholar
  4. 4.
    Imazio M, Adler Y. Management of pericardial effusion. Eur Heart J. 2013;34(16):1186–97.CrossRefPubMedGoogle Scholar
  5. 5.
    Shabetai R. Pericardial and cardiac pressure. Circulation. 1988;77(1):1–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Beck C. Two cardiac compression triads. JAMA. 1935;104:714–6.CrossRefGoogle Scholar
  7. 7.
    Brown J, MacKinnon D, King A, Vanderbush E. Elevated arterial blood pressure in cardiac tamponade. N Engl J Med. 1992;327(7):463–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Spodick DH. Pericardial rub. Prospective, multiple observer investigation of pericardial friction in 100 patients. Am J Cardiol. 1975;35(3):357–62.CrossRefPubMedGoogle Scholar
  9. 9.
    Sulzbach LM. Measurement of pulsus paradoxus. Focus Crit Care/Am Assoc Crit Care Nurses. 1989;16(2):142–5.Google Scholar
  10. 10.
    Spodick DH. Acute cardiac tamponade. N Engl J Med. 2003;349(7):684–90.CrossRefPubMedGoogle Scholar
  11. 11.
    Cheitlin MD, Armstrong WF, Aurigemma GP, et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Circulation. 2003;108(9):1146–62.CrossRefPubMedGoogle Scholar
  12. 12.
    Authors/Task Force M, Adler Y, Charron P, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015;36(42):2921–64.Google Scholar
  13. 13.
    Wann S, Passen E. Echocardiography in pericardial disease. J Am Soc Echocardiogr. 2008;21(1):7–13.CrossRefPubMedGoogle Scholar
  14. 14.
    Syed FF, Ntsekhe M, Mayosi BM, Oh JK. Effusive-constrictive pericarditis. Heart Fail Rev. 2013;18(3):277–87.CrossRefPubMedGoogle Scholar
  15. 15.
    Sagrista-Sauleda J, Angel J, Sambola A, Alguersuari J, Permanyer-Miralda G, Soler-Soler J. Low-pressure cardiac tamponade: clinical and hemodynamic profile. Circulation. 2006;114(9):945–52.CrossRefPubMedGoogle Scholar
  16. 16.
    Silvestry FE, Kerber RE, Brook MM, et al. Echocardiography-guided interventions. J Am Soc Echocardiogr. 2009;22(3):213–31; quiz 316–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Vayre F, Lardoux H, Pezzano M, Bourdarias JP, Dubourg O. Subxiphoid pericardiocentesis guided by contrast two-dimensional echocardiography in cardiac tamponade: experience of 110 consecutive patients. Eur J Echocardiogr. 2000;1(1):66–71.CrossRefPubMedGoogle Scholar
  18. 18.
    Tsang TS, Enriquez-Sarano M, Freeman WK, et al. Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc. 2002;77(5):429–36.CrossRefPubMedGoogle Scholar
  19. 19.
    Pradhan R, Okabe T, Yoshida K, Angouras DC, DeCaro MV, Marhefka GD. Patient characteristics and predictors of mortality associated with pericardial decompression syndrome: a comprehensive analysis of published cases. Eur Heart J Acute Cardiovasc Care. 2015;4(2):113–20.CrossRefPubMedGoogle Scholar
  20. 20.
    El Haddad D, Iliescu C, Yusuf SW, et al. Outcomes of cancer patients undergoing percutaneous pericardiocentesis for pericardial effusion. J Am Coll Cardiol. 2015;66(10):1119–28.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Seferovic PM, Ristic AD, Maksimovic R, Tatic V, Ostojic M, Kanjuh V. Diagnostic value of pericardial biopsy: improvement with extensive sampling enabled by pericardioscopy. Circulation. 2003;107(7):978–83.CrossRefPubMedGoogle Scholar
  22. 22.
    Sagrista-Sauleda J, Angel J, Sanchez A, Permanyer-Miralda G, Soler-Soler J. Effusive-constrictive pericarditis. N Engl J Med. 2004;350(5):469–75.CrossRefPubMedGoogle Scholar
  23. 23.
    Ntsekhe M, Matthews K, Syed FF, et al. Prevalence, hemodynamics, and cytokine profile of effusive-constrictive pericarditis in patients with tuberculous pericardial effusion. PLoS One. 2013;8(10), e77532.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • David D. Berg
    • 1
  • Gregory W. Barsness
    • 2
  • Benjamin A. Olenchock
    • 1
    Email author
  1. 1.Department of Medicine, Division of Cardiovascular MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Department of Cardiovascular Diseases, Division of Ischemic Heart Disease and Critical Care CardiologyMayo ClinicRochesterUSA

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