Intrapericardial Tetracycline for the Management of Cardiac Tamponade Secondary to Malignant Pericardial Effusion

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Abstract
CARDIAC tamponade is an acute, life-threatening complication of malignant pericardial effusions. There have been conflicting views on the management of this clinical situation1; traditionally, the approach has been surgical, with establishment of a pericardial window, or conservative, pericardiocentesis with local instillation of chemotherapeutic agents being used. A recent review of the literature by Smith et al.2 suggests that conservative therapy is safer and associated with a longer symptom-free interval. Mechlorethamine (nitrogen mustard), thiophosphoramide (thiotepa) and quinacrine (Atabrine) are the most commonly used agents for intrapericardial instillation. However, these agents cause severe pain, and the alkylating agents cause bone-marrow toxicity. . . .