Prolonged distress and clinical deterioration before pericardial drainage in patients with cardiac tamponade

OBJECTIVE: To determine whether patients with cardiac tamponade are subject to delays and clinical deterioration before undergoing echocardiography an d pericardial drainage. DESIGN: Retrospective study. SETTING: The Montreal Heart institute, Montreal, Quebec, a cardiology refer ral centre. PATIENTS: The charts of 50 patients who presented with tamponade were revie wed. Intervals between the appearance of symptoms, consultation, echocardio graphy and drainage were noted. The presence of clinical deterioration befo re drainage was evaluated. Causes for delays were investigated. RESULTS: Previous cardiac surgery (74%) was the most common etiology of tam ponade. Symptoms were present 6.6 +/- 5.8 days before consultation. The del ay between consultation and echocardiography was 1.2 +/- 2.0 days (range 0 to 12), and that between echocardiography and drainage was 0.8 +/- 0.9 days (range 0 to four). Patients underwent drainage 1.9 +/- 2.5 days (range 0 t o 16) after the initial consultation. Deterioration of the clinical status was noted in 34% of patients before pericardial drainage. An error in the i nitial diagnosis was present in 36% of patients; the majority of these were incorrectly diagnosed with heart failure. Another 44% of patients had no m ention of either a working diagnosis in the chart at admission or the desir e to rule out tamponade on the request for echocardiography. CONCLUSION: The proper diagnosis does not appear to be initially considered in up to 80% of patients who present with cardiac tamponade. Clinical dete rioration occurs in approximately a third of patients during the interval b etween consultation and pericardial drainage.