You Found an Effusion, Now What? Echo Recognition of Tamponade

A pericardial effusion is a common finding on transthoracic echocardiography (TTE), but its clinical significance ranges from incidental to life-threatening cardiac tamponade.

The true skill in echocardiography lies not just in identifying fluid around the heart, but in determining when a pericardial effusion is impairing diastolic filling and cardiac output. Tamponade is driven by pressure, not volume, which means effusion size alone can be misleading—particularly in acute presentations.

This lesson focuses on how to assess tamponade with echocardiography, emphasizing Doppler and structural findings that change management. You’ll learn how to identify exaggerated respiratory variation, interpret inflow patterns with or without a respirometer, and recognize key signs including IVC dilation, right atrial systolic collapse, and right ventricular diastolic collapse.

These are the echocardiographic findings that guide urgent clinical decisions and, at times, save lives.