[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Cardiovascular system](https://durgical.com/en/clinical-exam/#a-cardiovascular) › Cardiac tamponade: Beck triad and pulsus paradoxus [Clinical exam](https://durgical.com/en/clinical-exam/) · [Cardiovascular system](https://durgical.com/en/clinical-exam/#a-cardiovascular) # Cardiac tamponade: Beck triad and pulsus paradoxus - Syndrome Fluid or blood under pressure in the sac around the heart stops it from filling; it is an emergency recognized at the bedside. Updated 2026-11-01 **See it in 3D:** [Pericardium](https://durgical.com/en/anatomy/pericardium/) · [Right atrium](https://durgical.com/en/anatomy/right-atrium/) · [Right ventricle](https://durgical.com/en/anatomy/right-ventricle/) · [Internal jugular vein](https://durgical.com/en/anatomy/internal-jugular-vein/) ## Key points - Beck: hypotension, distended neck veins and muffled heart sounds. - Pulsus paradoxus of more than 10 mmHg. - Obstructive shock with clear lungs. - Electrical alternans on ECG; echo with diastolic collapse of the right chambers. ## What it is Tamponade occurs when pressure inside the pericardium exceeds right heart filling pressure. Output falls and obstructive shock follows. Beck triad and pulsus paradoxus are the classic signs; echocardiography confirms. ## Key findings - Beck triad: hypotension, jugular venous distension and muffled heart sounds. - Pulsus paradoxus: inspiratory systolic fall of more than 10 mmHg. - Tachycardia, tachypnea, usually clear lungs, anxiety, cool skin. - Jugular waveform without a y descent; the Kussmaul sign belongs more to constriction. - ECG: low-voltage complexes and electrical alternans. ## Pathophysiology - The pericardium stretches little: a rapid collection, even if small, raises pressure sharply; a slow one can be large before causing symptoms. - The low-pressure right chambers are the first to collapse in diastole. - On inspiration the right ventricle fills more and pushes the septum toward the left (ventricular interdependence): systolic pressure falls, giving pulsus paradoxus. - Venous pressure rises because blood cannot enter the heart. ## Common causes - Penetrating chest trauma and recent cardiac surgery or procedures. - Viral, bacterial and tuberculous pericarditis (relevant in Colombia and the region), uremia, metastatic cancer. - Proximal aortic dissection and free-wall rupture after infarction. - Hypothyroidism, lupus and other autoimmune diseases. ## Tests that confirm it - Bedside echocardiography: effusion with diastolic collapse of the right atrium and ventricle and a dilated inferior vena cava without respiratory variation. - Chest X-ray: 'water-bottle' silhouette only if the effusion is large and slow. - It is a clinical and ultrasound diagnosis; other tests are not awaited in an unstable patient. ## Memory aid 'Down, up and quiet': pressure goes down, the neck veins go up, the heart goes quiet. ## Test yourself Think of the answer, then tap the question to see it. ## What are the components of Beck triad? Hypotension, jugular venous distension and muffled heart sounds. ## Why does pulsus paradoxus appear in tamponade? On inspiration the right ventricle fills more and, since the heart cannot expand, the septum compresses the left ventricle and stroke volume falls. ## Which ECG finding suggests a large pericardial effusion with tamponade? Electrical alternans, together with low-voltage complexes. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/clinical-exam/cardiac-tamponade-beck-triad-and-pulsus-paradoxus/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Pericardium](https://durgical.com/en/anatomy/pericardium/) - [Right atrium](https://durgical.com/en/anatomy/right-atrium/) - [Right ventricle](https://durgical.com/en/anatomy/right-ventricle/) - [Internal jugular vein](https://durgical.com/en/anatomy/internal-jugular-vein/) ## Related - [Abnormal pulses: paradoxus, alternans, parvus et tardus, bounding](https://durgical.com/en/clinical-exam/abnormal-pulses-paradoxus-alternans-parvus-et-tardus-bounding/) - [Jugular venous pressure and the venous pulse](https://durgical.com/en/clinical-exam/jugular-venous-pressure-and-the-venous-pulse/) - [Shock: the clinical signs and the types](https://durgical.com/en/clinical-exam/shock-the-clinical-signs-and-the-types/) - [Heart sounds: S1, S2 and its splitting, S3 and S4](https://durgical.com/en/clinical-exam/heart-sounds-s1-s2-and-its-splitting-s3-and-s4/) - [Chest pain: ischemic, pericardial, pleural and other patterns](https://durgical.com/en/clinical-exam/chest-pain-ischemic-pericardial-pleural-and-other-patterns/) ## Related conditions - [Cardiac tamponade](https://durgical.com/en/conditions/cardiac-tamponade/) - [Acute pericarditis](https://durgical.com/en/conditions/acute-pericarditis/) - [Aortic dissection](https://durgical.com/en/conditions/aortic-dissection/) - [Mechanical complications of myocardial infarction](https://durgical.com/en/conditions/mechanical-complications-of-myocardial-infarction/) - [Pulmonary tuberculosis](https://durgical.com/en/conditions/pulmonary-tuberculosis/) - [Constrictive pericarditis](https://durgical.com/en/conditions/constrictive-pericarditis/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis. Sources: [Cardiac tamponade: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000194.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [Pericarditis: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000182.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [Shock: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000039.htm) (MedlinePlus, U.S. National Library of Medicine, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/cardiac-tamponade-beck-triad-and-pulsus-paradoxus/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/cardiac-tamponade-beck-triad-and-pulsus-paradoxus/