[Diagnosis and therapy of cardiac tamponade. An analysis of 50 patients].

Cardiac tamponade (CT) is a life-threatening complication of pericardial effusion which must be diagnosed and treated as soon as possible. The diagnostic value of the various symptoms and clinical signs, and the problems of pericardial puncture and drainage are reviewed in a group of 50 patients. Dyspnea was the most frequent symptom (92%), while elevated jugular venous pressure and pulsus paradoxus were the dominant findings in all patients. Non-specific enlargement of cardiac shadow on chest x-ray (98%) and low voltage in the electrocardiogram (62%) also provided important diagnostic information. However, echocardiography was the most reliable method of confirming the presence of pericardial fluid and assessing its quantity. The underlying cause of CT was most often malignant tumor (58%), followed by uremia (16%), idiopathic pericarditis (12%) and post-cardiotomy syndrome (10%). Removal of the pericardial fluid resulted in rapid improvement in all cases. Left parasternal drainage under echocardiographic control in 23 patients with a broad (greater than 10 mm) anterior echofree space proved to be a rapid and safe alternative to subxiphoidal puncture or surgical drainage. Longterm prognosis depends on the underlying disease. As might be expected, survival time is usually short in malignant pericarditis; however, even such cases warrant active treatment to relieve subjective symptoms.