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Cardiac tamponade

Nature Reviews Disease Primers volume 9, Article number: 36 (2023) Cite this article

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Abstract

Cardiac tamponade is a medical emergency caused by the progressive accumulation of pericardial fluid (effusion), blood, pus or air in the pericardium, compressing the heart chambers and leading to haemodynamic compromise, circulatory shock, cardiac arrest and death. Pericardial diseases of any aetiology as well as complications of interventional and surgical procedures or chest trauma can cause cardiac tamponade. Tamponade can be precipitated in patients with pericardial effusion by dehydration or exposure to certain medications, particularly vasodilators or intravenous diuretics. Key clinical findings in patients with cardiac tamponade are hypotension, increased jugular venous pressure and distant heart sounds (Beck triad). Dyspnoea can progress to orthopnoea (with no rales on lung auscultation) accompanied by weakness, fatigue, tachycardia and oliguria. In tamponade caused by acute pericarditis, the patient can experience fever and typical chest pain increasing on inspiration and radiating to the trapezius ridge. Generally, cardiac tamponade is a clinical diagnosis that can be confirmed using various imaging modalities, principally echocardiography. Cardiac tamponade is preferably resolved by echocardiography-guided pericardiocentesis. In patients who have recently undergone cardiac surgery and in those with neoplastic infiltration, effusive–constrictive pericarditis, or loculated effusions, fluoroscopic guidance can increase the feasibility and safety of the procedure. Surgical management is indicated in patients with aortic dissection, chest trauma, bleeding or purulent infection that cannot be controlled percutaneously. After pericardiocentesis or pericardiotomy, NSAIDs and colchicine can be considered to prevent recurrence and effusive–constrictive pericarditis.

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Fig. 1: Anatomical changes to the heart during cardiac tamponade.
Fig. 2: Pressure–volume curves depicting acute and chronic pericardial effusion.
Fig. 3: Diagnostic techniques in cardiac tamponade.
Fig. 4: Echocardiography and pericardiocentesis in cardiac tamponade.
Fig. 5: Echocardiography in the differential diagnosis of cardiac tamponade.
Fig. 6: Cardiac MRI in assessment of pericarditis.

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Acknowledgements

The authors dedicate this Primer to the giants in the field of pericardial diseases: David H. Spodick, Ralph Shabetai and Bernhard Maisch.

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Authors and Affiliations

  1. Sackler Faculty of Medicine, Tel Aviv University, Bnei Brak, Israel

    Yehuda Adler

  2. College of Law and Business, Ramat Gan, Israel

    Yehuda Adler

  3. Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia

    Arsen D. Ristić & Petar M. Seferović

  4. Faculty of Medicine, Belgrade University, Belgrade, Serbia

    Arsen D. Ristić, Ivana Burazor & Petar M. Seferović

  5. Cardiothoracic Department, Cardiology, University Hospital Santa Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy

    Massimo Imazio

  6. Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, The University of Milan, Milan, Italy

    Antonio Brucato

  7. Department of Internal Medicine-Cardiology, Philipps University Marburg, Marburg, Germany

    Sabine Pankuweit

  8. Institute for Cardiovascular Diseases “Dedinje“ and Belgrade University, Faculty of Medicine, Belgrade, Serbia

    Ivana Burazor

  9. Serbian Academy of Sciences and Arts, Belgrade, Serbia

    Petar M. Seferović

  10. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA

    Jae K. Oh

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Contributions

Introduction (Y.A., A.D.R. and I.B.); Epidemiology (Y.A., A.B., S.P. and I.B.); Mechanisms/pathophysiology (Y.A., M.I., S.P. and P.M.S.); Diagnosis, screening and prevention (Y.A. and M.I.); Management (Y.A., A.D.R., M.I., A.B. and J.K.O.); Quality of life (Y.A., A.D.R. and P.M.S.); Outlook (A.B., Y.A. and I.B.). Y.A. and A.D.R. contributed equally to the Primer.

Corresponding author

Correspondence to Yehuda Adler.

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Competing interests

The institution of A.B. received funding from Kiniksa Pharmaceuticals as an investigative site. A.B. also received an unrestricted research grant from Swedish Orphan Biovitrum AB (SOBI) and ACARPIA as well as travel and accommodation to attend an advisory committee organized by SOBI and an advisory board organized by Kiniksa Pharmaceuticals. The other authors declare no competing interests.

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Nature Reviews Disease Primers thanks A. Abbate, M. Chetrit, C. L. Jellis, M. M. Lewinter and J.-L. Vincent for their contribution to the peer review of this work.

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Supplementary information

41572_2023_446_MOESM1_ESM.mp4

Supplementary Video 1. Echocardiography in the diagnosis of cardiac tamponade. Two-dimensional echocardiographic apical long-axis view showing a large pericardial effusion with characteristic right atrial and right ventricular collapse in real time.

41572_2023_446_MOESM2_ESM.mp4

Supplementary Video 2. Echocardiography in the diagnosis of cardiac tamponade. Two-dimensional echocardiographic subxiphoid view showing the swinging heart in the large effusion.

41572_2023_446_MOESM3_ESM.mp4

Supplementary Video 3. Echocardiography in the diagnosis of cardiac tamponade. Two-dimensional echocardiographic parasternal long-axis view showing a large pericardial effusion with characteristic ventricular septal motion in real time.

41572_2023_446_MOESM4_ESM.mp4

Supplementary Video 4. Echocardiography in the diagnosis of cardiac tamponade. M-mode echocardiography of a large pericardial effusion with characteristic ventricular septal motion in real time.

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Adler, Y., Ristić, A.D., Imazio, M. et al. Cardiac tamponade. Nat Rev Dis Primers 9, 36 (2023). https://doi.org/10.1038/s41572-023-00446-1

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