This study emphasizes several factors that were of value in the diagnosis, prognosis, and treatment of a series of 200 patients with penetrating wounds of the pericardium or its contents. Cardiorrhaphy was performed in 187 cases, and pericardicentesis was used mainly as a diagnostic and temporary therapeutic measure. The individual physical signs that make up Beck's triad had limited diagnostic value, but did correlate somewhat with prognosis. Twenty-two deaths were related primarily to bleeding, five to myocardial infarctions from lacerated coronary arteries, and nine to a combination of bleeding, tamponade, and/or infarction. Because of the great importance of bleeding as a cause of death, cardiorrhaphy should be rapidly performed on all patients except those who achieve and maintain normal vital signs after pericardicentesis, with minimal or no blood replacement.
Wilson RF, Bassett JS. Penetrating Wounds of the Pericardium or Its Contents. JAMA. 1966;195(7):513-518. doi:10.1001/jama.1966.03100070057017