title: Prolonged distress and clinical deterioration before pericardial drainage in patients with cardiac tamponade.
abstract: OBJECTIVE
  To determine whether patients with cardiac tamponade are subject to delays and clinical deterioration before undergoing echocardiography and pericardial drainage.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  The Montreal Heart Institute, Montreal, Quebec, a cardiology referral centre.
  
  
  METHODS
  The charts of 50 patients who presented with tamponade were reviewed. Intervals between the appearance of symptoms, consultation, echocardiography and drainage were noted. The presence of clinical deterioration before drainage was evaluated. Causes for delays were investigated.
  
  
  RESULTS
  Previous cardiac surgery (74%) was the most common etiology of tamponade. Symptoms were present 6.6+/-5.8 days before consultation. The delay 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 to 16) after the initial consultation. Deterioration of the clinical status was noted in 34% of patients before pericardial drainage. An error in the initial diagnosis was present in 36% of patients; the majority of these were incorrectly diagnosed with heart failure. Another 44% of patients had no mention of either a working diagnosis in the chart at admission or the desire to rule out tamponade on the request for echocardiography.
  
  
  CONCLUSIONS
  The proper diagnosis does not appear to be initially considered in up to 80% of patients who present with cardiac tamponade. Clinical deterioration occurs in approximately a third of patients during the interval between consultation and pericardial drainage.
authors.affiliation: Montreal Heart Institute, Montreal, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Larose
authors.forename: A
authors.initials: A
authors.lastname: Ducharme
authors.forename: L A
authors.initials: LA
authors.lastname: Mercier
authors.forename: G
authors.initials: G
authors.lastname: Pelletier
authors.forename: F
authors.initials: F
authors.lastname: Harel
authors.forename: J C
authors.initials: JC
authors.lastname: Tardif
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002305:Cardiac Tamponade / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014463:Ultrasonography