Skip to main content
NCBI home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2009 Feb 3;22(7):446–452. doi: 10.1002/clc.4960220703

Diagnosis and management of cardiac tamponade in the era of echocardiography

Teresa S M Tsang 1,✉, Jae K Oh 1, James B Seward 1
PMCID: PMC6656203  PMID: 10410287

Abstract

Cardiac tamponade is a life‐threatening condition. Accurate diagnosis and prompt intervention are necessary. Classically, clinical features of tamponade include pulsus paradoxus, tachycardia, increased jugular venous pressure, and hypotension. With the advent of echocardiography, confirmation of an effusion and accurate assessment of its hemodynamic impact can be achieved, frequently in the absence of overt clinical manifestations. The decision regarding treatment and timing of intervention must take into account the clinical presentation and echocardiographic findings, along with careful weighing of risks and benefits to the individual patient. Echocardiographically guided pericardiocentesis is the best available therapy for initial management of cardiac tamponade. It is simple, safe, and effective for removing pericardial fluid and reversing hemodynamic instability, and the use of a pericardial catheter for extended drainage has been associated with significant reduction in recurrence of fluid accumulation.

Keywords: cardiac tamponade, Doppler, echocardiography, pericardial effusion, pericardiocentesis

Full Text

The Full Text of this article is available as a PDF (1.0 MB).

References

  • 1. Sharp JT, Bunnell IL, Holland JF, Griffith GT, Greene DG: Hemodynamics during induced cardiac tamponade in man. Am J Med 1960; 29: 640–646 [Google Scholar]
  • 2. Beck CS: Two cardiac compression triads. J Am Med Assoc 1935; 104: 714–716 [Google Scholar]
  • 3. Guberman BA, Fowler NO, Engel PJ, Gueron M, Allen JM: Cardiac tamponade in medical patients. Circulation 1981; 64: 633–640 [DOI] [PubMed] [Google Scholar]
  • 4. Feigenbaum H, Waldhausen JA, Hyde LP: Ultrasound diagnosis of pericardial effusion. J Am Med Assoc 1965; 191: 711–714 [DOI] [PubMed] [Google Scholar]
  • 5. Schutzman JJ, Obarski TP, Pearce GL, Klein AL: Comparison of Doppler and two‐dimensional echocardiography for assessment of pericardial effusion. Am J Cardiol 1992; 70: 1353–1357 [DOI] [PubMed] [Google Scholar]
  • 6. Kronzon I, Cohen ML, Winer HE: Diastolic atrial compression: A sensitive echocardiographic sign of cardiac tamponade. J Am Coll Cardiol 1983; 2: 770–775 [DOI] [PubMed] [Google Scholar]
  • 7. Armstrong WF, Schilt BF, Helper DJ, Dillon JC, Feigenbaum H: Diastolic collapse of the right ventricle with cardiac tamponade: An echocardiographic study. Circulation 1982; 65: 1491–1496 [DOI] [PubMed] [Google Scholar]
  • 8. Settle HP, Adolph RJ, Fowler NO, Engel P, Agruss NS, Levenson NI: Echocardiographic study of cardiac tamponade. Circulation 1977; 56: 951–959 [DOI] [PubMed] [Google Scholar]
  • 9. Himelman RB, Kircher B, Rockey DC, Schiller NB: Inferior vena cava plethora with blunted respiratory response: A sensitive echocardiographic sign of cardiac tamponade. J Am Coll Cardiol 1988; 12: 1470–1477 [DOI] [PubMed] [Google Scholar]
  • 10. Feigenbaum H, Zaky A, Grabhorn LL: Cardiac motion in patients with pericardial effusion. A study using reflected ultrasound. Circulation 1966; 34: 611–619 [DOI] [PubMed] [Google Scholar]
  • 11. Kronzon I, Cohen ML, Winer HE: Contribution of echocardiography to the understanding of the pathophysiology of cardiac tamponade. J Am Coll Cardiol 1983; 1: 1180–1182 [DOI] [PubMed] [Google Scholar]
  • 12. Fusman B, Schwinger ME, Charney R, Ausubel K, Cohen MV: Isolated collapse of left‐sided heart chambers in cardiac tamponade: Demonstration by two‐dimensional echocardiography. Am Heart J 1991; 121: 613–616 [DOI] [PubMed] [Google Scholar]
  • 13. Frey MJ, Berko B, Palevsky H, Hirshfeld JW Jr, Herrmann HC: Recognition of cardiac tamponade in the presence of severe pulmonary hypertension. Ann Intern Med 1989; 111: 615–617 [DOI] [PubMed] [Google Scholar]
  • 14. Appleton CP, Hatle LK, Popp RL: Cardiac tamponade and pericardial effusion: Respiratory variation in transvalvular flow velocities studied by Doppler echocardiography. J Am Coll Cardiol 1988; 11: 1020–1030 [DOI] [PubMed] [Google Scholar]
  • 15. Burstow DJ, Oh JK, Bailey KR, Seward JB, Tajik AJ: Cardiac tamponade: Characteristic Doppler observations. Mayo Clin Proc 1989; 64: 312–324 [DOI] [PubMed] [Google Scholar]
  • 16. Oh JK, Seward JB, Tajik AJ: The Echo Manual. Boston: Little, Brown and Company, 1994. [Google Scholar]
  • 17. Berge KH, Lanier WL, Reeder GS: Occult cardiac tamponade detected by transesophageal echocardiography. Mayo Clin Proc 1992; 67: 667–670 [DOI] [PubMed] [Google Scholar]
  • 18. Hutchison SJ, Smalling RG, Albornoz M, Colletti P, Tak T, Chandraratna PA: Comparison of transthoracic and transesophageal echocardiography in clinically overt or suspected pericardial heart disease. Am J Cardiol 1994; 74: 962–965 [DOI] [PubMed] [Google Scholar]
  • 19. Kochar GS, Jacobs LE, Kotler MN: Right atrial compression in postoperative cardiac patients: Detection by transesophageal echocardiography. J Am Coll Cardiol 1990; 16: 511–516 [DOI] [PubMed] [Google Scholar]
  • 20. Castello R, Pearson AC, Lenzen P, Labovitz AJ: Evaluation of pulmonary venous flow by transesophageal echocardiography in subjects with a normal heart: Comparison with transthoracic echocardiography. J Am Coll Cardiol 1991; 18: 65–71 [DOI] [PubMed] [Google Scholar]
  • 21. Nishimura RA, Abel MD, Hatle LK, Tajik AJ: Relation of pulmonary vein to mitral flow velocities by transesophageal Doppler echocardiography. Effect of different loading conditions. Circulation 1990; 81: 1488–1497 [DOI] [PubMed] [Google Scholar]
  • 22. Antman EM, Cargill V, Grossman W: Low‐pressure cardiac tamponade. Ann Intern Med 1979; 91: 403–406 [DOI] [PubMed] [Google Scholar]
  • 23. Gillam LD, Guyer DE, Gibson TC, King ME, Marshall JE, Weyman AE: Hydrodynamic compression of the right atrium: A new echocardiographic sign of cardiac tamponade. Circulation 1983; 68: 294–301 [DOI] [PubMed] [Google Scholar]
  • 24. Brown J, MacKinnon D, King A, Vanderbush E: Elevated arterial blood pressure in cardiac tamponade. N Engl J Med 1992; 327: 463–466 [DOI] [PubMed] [Google Scholar]
  • 25. Reddy PS, Curtiss EI, Uretsky BF: Spectrum of hemodynamic changes in cardiac tamponade. Am J Cardiol 1990; 66: 1487–1491 [DOI] [PubMed] [Google Scholar]
  • 26. Levine MJ, Lorell BH, Diver DJ, Come PC: Implications of echocardiographically assisted diagnosis of pericardial tamponade in contemporary medical patients: Detection before hemodynamic embarrassment. J Am Coll Cardiol 1991; 17: 59–65 [DOI] [PubMed] [Google Scholar]
  • 27. Tsang TSM, Freeman WK, Barnes ME, Reeder GS, Packer DL, Seward JB: Rescue echocardiographically guided pericardiocentesis for cardiac perforation complicating catheter‐based procedures: The Mayo Clinic experience. J Am Coll Cardiol 1998; 32: 1345–1350 [DOI] [PubMed] [Google Scholar]
  • 28. Ziskind AA, Pearce AC, Burstein S, Herrmann HC, Gimple LW, Block PC, Waldman HM, Tuzcu EM, Lemmon C, Palacios IF: Percutaneous balloon pericardiotomy for the treatment of pericardial effusion and tamponade: Report of the Registry (abstr). J Am Coll Cardiol 1992; 19 (suppl A): 265A [DOI] [PubMed] [Google Scholar]
  • 29. Moores DW, Dziuban SW Jr: Pericardial drainage procedures. Chest Surg Clin N Am 1995; 5: 359–373 [PubMed] [Google Scholar]
  • 30. Buzaid AC, Garewal HS, Greenberg BR: Managing malignant pericardial effusion. West J Med 1989; 150: 174–179 [PMC free article] [PubMed] [Google Scholar]
  • 31. Vaitkus PT, Herrmann HC, LeWinter MM: Treatment of malignant pericardial effusion. J Am Med Assoc 1994; 272: 59–64 [PubMed] [Google Scholar]
  • 32. Wilkes JD, Fidias P, Vaickus L, Perez RP: Malignancy‐related pericardial effusion. 127 cases from the Roswell Park Cancer Institute. Cancer 1995; 76: 1377–1387 [DOI] [PubMed] [Google Scholar]
  • 33. Meyers DG, Bouska DJ: Diagnostic usefulness of pericardial fluid cytology. Chest 1989; 95: 1142–1143 [DOI] [PubMed] [Google Scholar]
  • 34. Piehler JM, Pluth JR, Schaff HV, Danielson GK, Orszulak TA, Puga FJ: Surgical management of effusive pericardial disease. Influence of extent of pericardial resection on clinical course. J Thorac Cardiovasc Surg 1985; 90: 506–516 [PubMed] [Google Scholar]
  • 35. Tsang TSM, El‐Najdawi KE, Freeman WK, Hagler DJ, Seward JB, O'Leary PW: Percutaneous echocardiographically guided pericardiocentesis in pediatric patients: Evaluation of safety and efficacy. J Am Soc Echocardiogr 1998; 11: 1072–1077 [DOI] [PubMed] [Google Scholar]
  • 36. Tsang TS, Freeman WK, Sinak LJ, Seward JB: Echocardiographically guided pericardiocentesis: Evolution and state‐of‐the‐art technique. Mayo Clin Proc 1998; 73: 647–652 [DOI] [PubMed] [Google Scholar]
  • 37. King SW, Pandian NG, Gardin JM: Doppler echocardiographic findings in pericardial tamponade and construction. Echocardiography 1988; 5: 361–372 [Google Scholar]
  • 38. Fraser RS, Viloria JB, Wang NS: Cardiac tamponade as a presentation of extracardiac malignancy. Cancer 1980; 45: 1697–1704 [DOI] [PubMed] [Google Scholar]
  • 39. Drummond JB, Seward JB, Tsang TS, Hayes SN, Miller FA Jr: Outpatient two‐dimensional echocardiography‐guided pericardiocentesis. J Am Soc Echocardiogr 1998; 11: 433–435 [DOI] [PubMed] [Google Scholar]
  • 40. Callahan JA, Seward JB, Nishimura RA, Miller FA Jr, Reeder GS, Shub C, Callahan MJ, Schattenberg TT, Tajik AJ: Two‐dimensional echocardiographically guided pericardiocentesis: Experience in 117 consecutive patients. Am J Cardiol 1985; 55: 476–479 [DOI] [PubMed] [Google Scholar]
  • 41. Kopecky SL, Callahan JA, Tajik AJ, Seward JB: Percutaneous pericardial catheter drainage: Report of 42 consecutive cases. Am J Cardiol 1986; 58: 633–635 [DOI] [PubMed] [Google Scholar]
  • 42. Ball JB, Morrison WL: Experience with cardiac tamponade following open heart surgery. Heart Vessels 1996; 11: 39–43 [DOI] [PubMed] [Google Scholar]
  • 43. Laham RJ, Cohen DJ, Kuntz RE, Baim DS, Lorell BH, Simons M: Pericardial effusion in patients with cancer: Outcome with contemporary management strategies. Heart 1996; 75: 67–71 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44. Isselbacher EM, Cigarroa JE, Eagle KA: Cardiac tamponade complicating proximal aortic dissection. Is pericardiocentesis harmful? Circulation 1994; 90: 2375–2378 [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES