Neoplastic cardiac tamponade.

Abstract

N EOPLASTIC cardiac tamponade is a very important emergency in clinical oncology, as it may appear abruptly and cause the death of a patient who has a potentially controllable tumor and a rather good life expectancy. This occurs when interference with the pumping action of the heart reaches a point at which a sudden sharp reduction in the stroke volume and cardiac output develops, followed rapidly by circulatory collapse and death. For this reason, a prompt decompression should follow recognition. Unfortunately, in many patients with cancer, this medical emergency is not recognized and even when diagnosed, a fatalistic approach dominates its clinical management. In patients with known malignancy, the pericardial effusion usually develops slowly and surreptitiously, and there may be warning symptoms and signs prior to the development of the clinical picture of tamponade. Occasionally, the tamponade may represent the first manifestation of a malignant solid tumor or even of a leukemia.‘-’ The usual cause of the neoplastic cardiac tamponade is a malignant pericardial effusion, and only rarely does tamponade develop acutely from a tumor that encases the heart in a thick constrictive neoplastic hull.6 Postirradiation pericarditis with fibrosis, effusion, or a combination of both may also cause cardiac tamponade;’ although, in these instances, the tumor is only indirectly responsible for the tamponade’s genesis, the resulting postradiotherapy tamponade will be included in the present review. In the majority of cases the cardiac tamponade represents a clinical progression of a neoplastic or postirradiation pericarditis, and for this reason, a brief review of these two nosologic entities will be presented first. Unfortunately, there are no prospective studies at present with an adequate number of patients to show how often these two conditions lead to cardiac tamponade.