Cardiac tamponade is an emergency clinical syndrome that occurs when blood or fluid fills the pericardial space, raising intrapericardial pressure and preventing ventricular diastolic filling. Consequently, venous pressures are greatly increased, and there is a reduction in stroke volume and cardiac output with the development of shock. Cardiac tamponade associated with cardiac trauma or aortic dissection requires immediate surgical intervention. Echocardiography can also exclude other causes of systemic venous hypertension and arterial hypotension such as constrictive pericarditis, cardiac dysfunction and right ventricular dysfunction. The chest x-ray can show an enlarged globular heart shadow if the effusion is chronic or a normal cardiac silhouette if the tamponade develops acutely as seen during cardiac rupture or laceration. A positive Kussmaul’s sign is rare in cardiac tamponade. Its presence suggests that an organizing process and epicardial constriction is present, in addition to an effusion. The apex beat may not be palpable and the heart sounds are soft or even absent.