Cardiac tamponade is pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle and the outer covering sac (pericardium) of the heart.
In this condition, blood or fluid collects in the sac surrounding the heart. This prevents the heart ventricles from expanding fully. The excess pressure from the fluid prevents the heart from working properly. As a result, the body does not get enough blood.
Cardiac tamponade can occur due to:
(thoracic)
End-stage lung cancer
Heart attack (
)
Heart surgery
caused by bacterial or viral infections
Wounds to the heart
Other possible causes include:
Heart tumors
Placement of central lines
Radiation therapy to the chest
Recent invasive heart procedures
Dermatomyositis
Heart failure
Cardiac tamponade due to disease occurs in about 2 out of 10,000 people.
Symptoms may include:
, restlessness
Sharp
that is felt in the neck, shoulder, back, or abdomen
Chest pain that gets worse with deep breathing or coughing
Discomfort, sometimes relieved by sitting upright or leaning forward
, lightheadedness
Pale, gray, or blue skin
Palpitations
Swelling of the legs or abdomen
Other symptoms that may occur with this disorder:
Drowsiness
Weak or absent pulse
An
is the test of choice to help make the diagnosis. This test may be done at the bedside in emergency cases.
A physical exam may show:
Blood pressure that falls when breathing deeply
Rapid breathing
Heart rate over 100 (normal is 60 to 100 beats per minute)
Heart sounds are only faintly heard through a stethoscope
Neck veins that may be bulging (distended) but the blood pressure is low
Weak or absent
pulses
Other tests may include:
or
Right heart catheterization
Cardiac tamponade is an emergency condition that needs to be treated in the hospital.
The fluid around the heart must be drained as quickly as possible.
A procedure that uses a needle to remove fluid
from the tissue that surrounds the heart will be done. This procedure is called pericardiocentesis.
A surgical procedure to cut and remove part of the covering of the heart may also be done. This is known as surgical pericardiectomy or pericardial window.
Fluids are given to keep blood pressure normal until the fluid can be drained from around the heart. Medicines that increase blood pressure may also help keep the person alive until the fluid is drained.
Oxygen may be given to help reduce the workload on the heart by decreasing tissue demands for blood flow.
The cause of tamponade must be found and treated.
Death due to cardiac tamponade can occur quickly if the fluid or blood is not removed promptly from within the pericardium.
The outcome is often good if the condition is treated promptly. However, tamponade may come back.
Go to the emergency room or call the local emergency number (such as 911) if symptoms develop. Cardiac tamponade is an emergency condition that needs immediate medical attention.
Many cases can't be prevented. Knowing your personal risk factors may help you get early diagnosis and treatment.
Tamponade; Pericardial tamponade; Pericarditis - tamponade
Hoit BD, Oh JK. Pericardial diseases. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 62.
Klein AL, Wang TKM, Lewinter MM, Cremer PC. Pericardial diseases. In: Bonow RO, Mann DL, Tomaselli, GF, et al, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 13th ed. Philadelphia, PA: Elsevier; 2026:chap 78.
Tewelde SZ, Menon R. Pericardiocentesis. In: Birnbaumer DM, ed. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 8th ed. Philadelphia, PA: Elsevier; 2026:chap 16.
Updated by: Mary C. Mancini, MD, PhD, Cardiothoracic Surgeon, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.