Cardiac tamponade | Nature Reviews Disease Primers

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.

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

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

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

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

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

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

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

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

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.

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.

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.

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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.

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

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.

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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