Key messages

• Cardiac tamponade is a low-flow state resulting from accumulation of blood or fluid in the pericardial sac that limits ventricular filling, stroke volume, and cardiac output.

• It may progress slowly with some degree of compensation, or develop rapidly into an acute tamponade syndrome with potentially lethal cardiogenic shock

• With slowly developing effusions, the pericardial sac is able to dilate and can accommodate 2 liters or more of fluid.

• Pulsus paradoxus is a useful sign in slowly developing pericardial effusions, but is not very useful in rapidly developing tamponade from penetrating injuries.

• Definitive diagnostic information can be provided by echocardiography, CT, and magnetic resonance imaging, and confirmed by pericardiocentesis.

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