Seventeen patients with acute myocardial infarction and tamponade after subacute ventricular free-wall rupture were treated with dextran, dobutamine, and pericardiocentesis before definitive surgical repair. In all of the patients the diagnosis was confirmed anatomically. Dextran (200 to 900 ml), administered to 10 patients, induced a significant increase in systolic blood pressure, cardiac index, stroke index, right atrial pressure, and pulmonary capillary pressure. Dobutamine (500 micrograms/min for 20 to 40 minutes), was infused in 16 patients and induced a significant increase in systolic blood pressure, cardiac index, stroke index, and heart rate. Pericardiocentesis, with extraction of 150 to 500 ml, was performed in five patients. It produced a significant increase in systolic blood pressure, cardiac index, and stroke index and a significant decrease in right atrial pressure and heart rate. The best results were obtained after pericardiocentesis. However, it must not be performed in every case because of its potential risk. Dextran and dobutamine may be sufficient in many cases to support these patients before surgery.
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