Cardiac tamponade in medical patients: treatment and prognosis in the echocardiographic era.

Experience was reviewed in the management of pericardial tamponade in 36 patients with emphasis on factors governing short and long-term survival. Malignant pericardial effusion was the most common etiology and accounted for pericardial tamponade in 14 of the 36 patients (39%). Of the 36 patients, three received medical therapy alone, 18 were treated by one or more needle pericardiocentesis, pericardial drains were inserted in six patients, and thoracotomy was performed in nine. Needle pericardiocentesis was attempted as the initial therapy in all but two patients and was initially successful in relieving tamponade in 30 patients. Twenty-four patients died during a follow-up of from 1 day to 6 years. Delay in diagnosing tamponade was frequent and accounted for three deaths. Two more patients died from recurrent tamponade following initial relief. Eighteen patients died primarily from complications related to their basic illness, though recurrent pericardial effusion was a contributory factor in five. One patient died following pericardiectomy. The remaining 12 patients are well and free of pericardial disease. Short-term survival in pericardial tamponade is mostly dependent upon early diagnosis and relief of tamponade. Long-term survival depends upon the prognosis of the primary illness, irrespective of the mode of treatment used.