- The files of 20 patients who required surgical intervention for cardiac tamponade between May 1976 and June 1983 were reviewed. The most frequently implicated etiological factors were viral or idiopathic (8 of 20 cases). Clinical signs of major importance were: tachycardia, 19 of 20; dyspnea, 17 of 20; and venous engorgement, 17 of 20. Valuable bedside examinations were the pulsus paradoxus for the cardiac tamponade of nontraumatic etiology and the central venous pressure examination for traumatic cardiac tamponade. Echocardiography was the most reliable laboratory examination. All patients were treated surgically either through a left thoracotomy or by the subxiphoid approach. Although both methods were equally effective in controlling this life-threatening condition, the latter technique resulted in a lower rate of postoperative complications.