SHM's Clinical Quick Talks-Cardiac Tamponade

Pdf Summary

Cardiac tamponade is a critical condition resulting from fluid accumulation in the pericardial space, which exceeds the pericardium's stretch capacity. This leads to increased intrapericardial pressure that surpasses right-sided heart filling pressures, impairing preload and reducing cardiac output and stroke volume. The syndrome can develop acutely or subacutely, and the rate of fluid accumulation, rather than the volume, determines the severity. <br /><br />The classic clinical triad of cardiac tamponade includes hypotension (from low cardiac output), elevated jugular venous pressure (from impaired venous return), and muffled heart sounds (due to fluid insulation). Additional clinical signs include pulsus paradoxus, tachycardia, and narrow pulse pressure. Diagnostic clues from an electrocardiogram may show low voltage and electrical alternans, while transthoracic echocardiography can reveal right atrial and right ventricular collapse, a dilated inferior vena cava with reduced respiratory variation, and sometimes a "swinging heart" sign.<br /><br />Etiologies include traumatic or post-myocardial infarction causes, iatrogenic factors, or conditions such as malignancy, uremia, tuberculosis, and autoimmune diseases like systemic lupus erythematosus. Management involves immediate bedside cardiac ultrasound to confirm the diagnosis, followed by stabilization with fluids and sometimes vasopressors, while avoiding diuretics and negative inotropes. Definitive treatment often requires pericardiocentesis, preferably echo-guided, or surgical intervention for more complex cases. Pericardial fluid analysis can aid diagnosis, especially in cases suspicious for tuberculosis or malignancy.<br /><br />Importantly, patients, particularly those with cancer or end-stage renal disease, may present subacutely without the classic triad. Diagnosis is mainly hemodynamic rather than radiologic, emphasizing the role of echocardiography in assessing physiology. Early recognition and intervention are crucial to prevent sudden cardiovascular collapse. Updated management guidelines were last reviewed in May 2025.

Asset Subtitle

Sruthi Shanmugam, Kathryn Haroldson

Keywords

cardiac tamponade

pericardial space

intrapericardial pressure

preload impairment

clinical triad

pulsus paradoxus

transthoracic echocardiography

pericardiocentesis

etiologies

hemodynamic diagnosis