Pericardial tamponade occurs when fluid within the pericardial sac impairs filling of the right-sided chambers, leading to a decrease in cardiac output and hemodynamic compromise. It is neither a clinical nor an echocardiographic diagnosis alone. Rather, the echocardiogram carries diagnostic value and should be performed when there is an elevated pre-test probability for tamponade based on the history and physical exam. Here, we will illustrate the core echocardiographic findings of pericardial tamponade.