Jan Droste

Dear Sir,

I read with interest the article by Ravikirti et al in the recent edition of Acute Medicine. The authors rightly highlight the potential for atypical presentations of tamponade following cardiac surgery, which has been reported previously. The investigation of any acutely unwell patient presenting after cardiac surgery should include some form of cardiac imaging. In the cases described the diagnosis was delayed, in part, due to the lack of an echocardiography service out-of-hours.