Author + information
- Received March 27, 1990
- Revision received June 27, 1990
- Accepted July 13, 1990
- Published online January 1, 1991.
- Jean Renkin, MD∗,
- Bernard De Bruyne, MD,
- Edouard Benit, MD,
- Jean-Marc Joris, MD,
- Marc Carlier, MD and
- Jacques Col, MD
- ↵∗Address for reprints: Jean Renkin, MD, Coronary Care Unit, Saint-Luc University Hospital, Avenue Hippocrate, 10, B-1200 Brussels, Belgium.
Among 392 consecutive patients admitted for acute myocardial infarction and treated with thrombolytic drugs, 4 patients (1%) developed an early hemorrhagic pericardial effusion (without ventricular wall rupture) evolving within 24 h to cardiogenic shock consequent to cardiac tamponade. They all suffered from a large anterior myocardial infarction treated within 4 h after onset of symptoms with intravenous anisoylated plasminogen streptokinase activator complex (one case), recombinanl tissue-type plasminogen activator (rt-PA) (two cases) or streptokinase (one case), anticoagulation with heparin (all cases) and aspirin (three cases).
As soon as pericardial effusion was established by echocardiography, emergency percutaneous pericardiocentesis was performed at the bedside 20 ± 6 h after thrombolytic therapy was started. This corrected immediately the clinical and hemodynamic status of each patient and a catheter was left in the pericardial space for 34 ± 18 h. Thus, in the presence of unexplained clinical and hemodynamic deterioration occurring during the first 24 h after thrombolytic treatment of a large myocardial infarction, cardiac tamponade should be suspected. Immediate percutaneous pericardiocentesis followed by continuous drainage is a simple and definitive treatment for this complication.
- Received March 27, 1990.
- Revision received June 27, 1990.
- Accepted July 13, 1990.