CARDIAC-TAMPONADE IN PATIENTS INFECTED WITH HIV - A REPORT FROM AN INNER-CITY HOSPITAL

Thirty-seven consecutive cases of cardiac tamponade occurring over a 6 -year period were retrospectively studied from january 1986 to Decembe r 1991 in an inner-city public teaching hospital. All episodes were se condary to medical illnesses. Thirteen (35 percent) of 37 patients had HIV infection. Significant differences (HIV vs non-HIV) in clinical p resentation were noted in the following parameters: (1) age (34 +/- 7 years vs 56 +/- 14 years, p<0.001); (2) febrile presentation (62 perce nt vs 17 percent, p<0.02); and (3) presence of pulmonary infiltrates ( 54 percent vs 17 percent, p<0.03). All but two patients underwent peri cardiocentesis or had operative creation of a pericardial window. Two patients had purulent pericarditis; two patients had tuberculous peric arditis. In the remaining patients, there was no evidence of opportuni stic infection or malignancy based on cultures of pericardial fluid an d histopathologic analysis of tissue. Six of 13 patients with HIV infe ction survived to be discharged from the hospital following hospitaliz ation for the illness. We conclude the following: (1) HIV infection is frequently found in patients with cardiac tamponade at inner city hos pitals; (2) when young patients present with cardiac tamponade, the co existence of fever and pulmonary infiltrates is suggestive of underlyi ng HIV infection; and (3) the etiology of the pericardial effusion is not confirmed in the majority of patients with HIV infection.