Low-Pressure Cardiac Tamponade: A Systematic Review of Diagnostic Criteria, Hemodynamic Profiles, and Management Challenges

Adam Maulana Yusup

doi:10.58344/ihj.v5i2.853

Authors

Adam Maulana Yusup Malangbong Regional Hospital, Indonesia

DOI:

https://doi.org/10.58344/ihj.v5i2.853

Keywords:

Echocardiography, Fluid Resuscitation, Hemodynamics, Low-Pressure Cardiac Tamponade, Pericardial Decompression Syndrome, Pericardial Effusion, Point-of-Care Ultrasound (POCUS)

Abstract

Low-Pressure Cardiac Tamponade (LPCT) is a deceptive subset of pericardial compressive syndromes characterized by tamponade physiology occurring at normal or low intracardiac pressures, primarily due to underlying hypovolemia. The absence of classical signs, such as jugular venous distension and pulsus paradoxus, frequently leads to misdiagnosis and mortality. This review aims to synthesize diagnostic criteria, hemodynamic profiles, and evidence-based management strategies for LPCT. A systematic review was conducted following PRISMA 2020 guidelines. Electronic databases (PubMed, Scopus, Embase) were searched through December 2025. Eighteen studies meeting specific hemodynamic criteria for LPCT and subacute presentations were included. Data regarding demographics, echocardiographic findings, and response to volume expansion were synthesized qualitatively. Analysis indicates that LPCT predominantly affects patients with malignancy, renal failure, or chronic inflammation. Hemodynamically, equilibration of diastolic pressures occurs at <12 mmHg due to critical preload reduction. The most consistent diagnostic profile identified is echocardiographic right atrial/ventricular collapse coexisting with a non-plethoric, collapsing inferior vena cava. Physical examination markers, including Beck’s triad, were unreliable. LPCT represents a "pre-tamponade" state masked by hypovolemia. Reliance on physical examination is insufficient; Point-of-Care Ultrasound (POCUS) is mandatory for diagnosis. We recommend a management algorithm centering on a "fluid challenge" (500–1000 mL) to unmask occult tamponade physiology and optimize preload prior to pericardiocentesis, thereby mitigating the risk of Pericardial Decompression Syndrome.

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