Pericardial tamponade due to penetrating fragment wounds of the heart

Ten cases of pericardial tamponade due to penetrating fragment wounds of the heart seen at a surgical hospital in Vietnam are presented. Two of the three deaths in this series were due to associated injuries. The diagnosis of pericardial tamponade must be suspected in any penetrating wound of the thorax or upper part of the abdomen, especially if the response to adequate blood and fluid replacement is suboptimal. The classical signs of pericardial tamponade, such as elevated central venous pressure, poor peripheral perfusion, and distant heart sounds, may be altered or nonspecific in the hypovolemic patient. Some cases of pericardial tamponade can be handled conservatively with initial pericardiocentesis. However, the advantages of early surgical decompression once the diagnosis is established seem so great that conservative treatment is rarely indicated.