Acute cardiac tamponade is considered a medical emergency. Diagnostic tests will be performed quickly and comprehensively to determine the appropriate course of treatment. Treatment will focus on the immediate reduction of fluid in the pericardial sac.

The treatment for cardiac tamponade is to aspirate (drain or remove through suction) fluid from the pericardium. This invasive process is known as pericardiocentesis. This technique entails numbing of the chest area with a local anesthetic followed by the insertion of a needle just below the breast bone (sternum) and into the pericardium. The needle is then replaced by a catheter and excess fluid is drained through the tube and into sterile containers.

Often, an echocardiogram is used to help guide the entry of the needle. This use of ultrasound imaging to assist in pericardiocentesis has greatly improved its safety and effectiveness. However, the procedure does have risks, and patients will be under close observation after the procedure. A hospital stay of several days should be expected, to monitor for a re-accumulation of fluid.

If pericardiocentesis is not successful, or if other complications are present, further intervention may be necessary. These procedures include the following:

• Percutaneous balloon pericardiotomy uses a balloon-tipped catheter to create a tear in the wall of the pericardium, through which a drainage tube can be inserted. The procedure only requires local anesthesia. It is most commonly performed in patients whose cardiac tamponade is cancer-related.
  
  
• Surgical pericardiotomy involves putting the patient “to sleep” with general anesthesia. The surgeon then makes a cut-down (incision) in the chest and pericardium to gain access for the drainage tube. Surgery is more likely if the fluid continues to re-accumulate, if the cause of the fluid accumulation remains obscure, or if the removal of the pericardial sac becomes necessary.
  
  
• Pericardiectomy is a type of operation in which part of the pericardium is surgically removed. This procedure may be done if scarring is present with cardiac tamponade or if a biopsy of the pericardium is necessary.

There are two main prevention strategies for cardiac tamponade, both of which are advised for people at high-risk of developing the condition:

• Taking anti-inflammatory medications (e.g., NSAIDs) to help prevent any fluid buildup in the pericardium from progressing to cardiac tamponade
  
  
• Learning the warning signs and symptoms of fluid buildup in the pericardium (pericardial effusion) and contacting a physician immediately if any of these are experienced.