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Effusions pericardial
Effusions pericardial
• Pericardial effusion is an accumulation of fluid in the
pericardium, the sac that holds your heart.
• When it happens quickly or involves a large amount of fluid, the
excess fluid can take up too much space in the pericardium,
compressing your heart and causing a life-threatening condition
known as cardiac tamponade. Pericardial effusion is a buildup of
fluid in the space around the heart.
• It can happen for a wide range of reasons, including infections,
injuries or other medical conditions. If the buildup is severe or
happens quickly, it can compress your heart and cause cardiac
tamponade, a life-threatening medical emergency.
• The pericardium is a double-walled sac that surrounds the heart.
Between the inner wall of the pericardium and your heart is a
thin layer of fluid, which cushions and protects your heart from
outside forces (much like bubble wrap around a fragile item
inside a shipping box).
• Under normal circumstances, the pericardium
has just enough fluid to cushion your heart, but
not so much fluid that your heart can’t expand
and fill up with blood with every heartbeat.
• Cardiac tamponade happens when there’s too
much fluid inside the pericardium, which means
your heart has no room to expand and fill up
with blood.
• Without quick treatment, it can cause your heart
to stop, which is eventually fatal within minutes
to hours.
Difference between pericardial
effusion and pleural effusion:
• Pleural effusion is similar to pericardial effusion, but it
happens in a different place inside your chest. The pleural
cavity is the sac that surrounds your lungs, and a pleural
effusion is when fluid fills up that space.
• A pleural effusion keeps your lungs from expanding as they
should, which makes it harder for you to breathe.
• Pericardial effusion can happen for a wide range of reasons.
Because of that, it can happen to people of any age or
background.
• It’s also a relatively common condition. However, there’s
very little data on exactly how common it is.
• Sometimes, pericardial effusion is an incidental finding on an
imaging test, meaning healthcare providers discover it without
intending to.
This condition affect my body:
• Every heartbeat starts with a pause where your heart muscle
relaxes and expands. That lets the chambers of the heart fill up with
blood before they squeeze. As the pericardium fills up, there's less
space for your heart to expand. Eventually, your heart doesn’t have
room to expand so its chambers can fill up with blood.
• An easy way to see how pericardial effusion affects your heart is
by trying to blow up a balloon inside of a plastic bottle. In this
example, your heart is the balloon and the bottle is the pericardium.
When the bottle is empty, there's more space for the balloon to
inflate. If you add water to the bottle, there's less space and you
can't blow up the balloon as much. If you keep filling the bottle,
eventually you can't blow up the balloon at all.
• As your heart pumps less and less blood, it speeds up to try to
make up for its limited pumping ability. Over time, your heart can't
keep up, and you go into cardiogenic shock, which makes your
heart stop. Without treatment, cardiogenic shock is deadly.
Symptoms:
• Pericardial effusions may not cause any symptoms, especially
when they’re small or happen slowly. Symptoms are more likely
when an effusion happens quickly, involves a large amount of fluid
or causes cardiac tamponade. The main symptoms of pericardial
effusions and cardiac tamponade include:
• Shortness of breath (dyspnea).
• Chest pressure or pain.
• Fast heartbeat or heart palpitations (the unpleasant feeling of your
own heartbeat without feeling for your pulse).
• Lightheadedness or dizziness.
• Fainting (syncope).
• Fatigue.
• Anxiety, confusion or other behavior changes (because of low
blood flow to the brain).
• Cyanosis (a blue or gray tinge to your lips or under your fingernails
that happens when you have low blood oxygen levels).
• If a pericardial effusion is large enough, it can press
on surrounding tissues or nerves. That can cause
symptoms like:
• Trouble swallowing (dysphagia).
• Hiccups.
• Coughing or hoarseness.
Causes pericardial effusion:
• Pericardial effusion can happen for many different
reasons. It often happens along with (or because
of) inflammation of the pericardium (pericarditis).
• Possible causes of pericardial effusion include:
• Infections. Pericardial effusion often happens because
of viral or bacterial infections, including human
immunodeficiency virus (HIV) and tuberculosis (though
this is less common in developed countries). It can also
happen because of fungal infections or parasites.
• Cancer. Tumors in the heart or that spread from
elsewhere in your body can cause damage to the
pericardium.
• Immune system conditions or inflammatory disorders.
These include lupus, rheumatoid arthritis or Sjögren’s
syndrome.
• Hormonal disorders or problems. An example of this
is hypothyroidism (where your thyroid gland isn’t producing
enough thyroid hormone).
• Trauma. Injuries to the chest, including blunt impacts (like
car crashes) and punctures from knives or bullets, can cause
pericardial effusion.
• Heart or circulatory problems. These include heart attacks
or aortic dissection (where layers on the inside of your aorta
separate or tear).
• Medical causes. Pericardial effusion can happen after heart
surgery, radiation therapy for cancer or as a side effect of
some medications.
• Other. Pericardial effusion can also happen with heart
failure, chronic kidney disease or kidney failure, liver
cirrhosis or for unknown reasons.
Pericardial effusion always a serious problem:
• Pericardial effusion is usually a significant
condition, but it isn’t always a medical emergency.
• Pericardial effusions may be small or large, and
sometimes smaller effusions go away on their own.
• Whether or not it’s a life-threatening emergency
depends on what caused it, the amount of fluid
involved, and how fast that fluid fills the
pericardium.
• When an effusion happens quickly, it needs less
fluid to become dangerous and cause cardiac
tamponade.
• That's because the pericardium doesn't have time
to stretch and expand to accommodate more fluid
inside it.
• When a pericardial effusion happens slowly, it can
take weeks or even months before it becomes a
problem.
• One factor that determines if a pericardial effusion
is serious is why it happened in the first place.
• When it happens because of injuries or heart and
circulatory problems (or any reason that can cause
an effusion to develop quickly), pericardial effusion
needs quick treatment to avoid dangerous
complications like cardiac tamponade.
Pericardial effusion diagnosed:
• If you have symptoms, a doctor will diagnose pericardial
effusion based on a combination of the symptoms you
describe, your medical history, medical testing, and examining
you for any signs and symptoms of this condition. Some of the
key signs include an unusual drop in your blood pressure
when you breathe in, muffled or unusual heart sounds, or
bulging of the jugular vein in your neck.
• If you don’t have symptoms, the most likely way a doctor will
diagnose pericardial effusion is if they happen to see it on
medical imaging for another reason. This kind of diagnosis is
called an incidental finding, and an example of this is a
pericardial effusion that’s visible on a chest X-ray after a car
accident.
• A wide range of tests is possible when healthcare providers
evaluate your symptoms or suspect a pericardial effusion.
Imaging tests
• Echocardiogram.
• Chest x-ray.
• Computed tomography (CT) scan of the chest.
• MRI of the heart
Electrocardiogram:
• This test measures the electrical activity of your
heart through a set of sensors (usually 10) called
electrodes, which attach to the skin of your chest.
• The electrodes detect your heart’s electrical activity
and show it as a wave on either a paper printout or
a screen display.
• Doctors can tell when your heart isn’t beating
properly because its electrical activity changes in
certain ways, some of which are very distinctive.
Lab tests
• Lab tests usually come after a provider diagnoses
pericardial effusion. These tests focus on finding out
why you have a pericardial effusion. The possible tests
include:
• Complete blood count.
• Troponin.
• B-type natriuretic peptide.
• Thyroid-stimulating hormone.
• Immune system tests (to look for immune system
disorders or inflammatory conditions).
• In some cases, tests on the fluid taken out of your
pericardium are also possible. Testing the fluid can
sometimes help doctors understand the underlying
cause behind the effusion
Treated:
• Pericardial effusions are often treatable. Whether or not
they’re curable depends on how severe they are and
why they happened.
• Your healthcare provider is the best person to tell you
what to expect from the treatment, including whether or
not your effusion is curable.
• Needle aspiration (pericardiocentesis): After numbing
a specific area on your chest and using imaging tools
(like echocardiography or fluoroscopy) for guidance, a
healthcare provider will insert a needle into your chest
until it is just inside the pericardium. They’ll then
aspirate (pull out) the excess fluid inside. Sometimes, a
thin, tube-like device is left inside the pericardium to
drain fluid for a few days until it is all gone.
Surgery
• In some cases, surgery is the best way to remove the
extra fluid inside the pericardium. Surgery can
happen in an emergency, or it can be a scheduled
procedure when an effusion causes symptoms but is
slow-growing and not dangerous.
• A common surgical procedure for this is video-
assisted thoracic surgery (VATS), which creates a
pericardial “window” to allow draining fluid to spill
into the larger pleural cavity so it doesn’t fill up the
pericardial space.
• In cases where an effusion isn’t dangerous and doesn’t
need any of the above treatments, it’s often possible to
treat it with medications or other types of treatments.
The treatments depend on the underlying cause. These
include, but aren’t limited to, the following:
• Antibiotics. These help by treating underlying
infections, such as tuberculosis, which can cause
pericarditis and effusions.
• Anti-inflammatory drugs. These help reduce
inflammation and swelling.
• Chemotherapy and radiation therapy. These help
when pericardial effusion happens because of cancer.
• Diuretics and other heart failure medications. These
help when heart failure is the cause behind a pericardial
effusion.
Potential side effects or
complications to the treatments:
• The possible side effects with treatments for pericardial
effusion depend strongly on which treatments or
medications you receive. Your healthcare provider is the
best person to tell you about what side effects are
possible with the medications you take because they can
tailor the information to fit your specific needs and
circumstances.
• A possible complication is pericardial decompression
syndrome when you undergo a procedure or surgery to
treat a pericardial effusion. While it isn't common, it is
severe and life-threatening. It usually happens when
fluid removal happens too quickly from a large
effusion. To avoid this, your healthcare provider may
drain the effusion more slowly.
Take care of myself/manage
symptoms:
• Pericardial effusion isn’t something you should try
to treat on your own unless you’ve spoken with a
healthcare provider.
• That’s because it isn’t possible to diagnose it
without specific medical tests and imaging. After
getting this diagnosis, you can ask your healthcare
provider what you can do to manage your
symptoms and limit their impact on your life.
After treatment will I feel better, and
how long does it take to recover:
• How long it takes you to feel better and recover
depends on three main factors:
• The cause of the effusion.
• The severity of the effusion.
• The treatments you received.
• Your overall health and whether or not you have any
other related medical conditions.
• In cases where you have symptoms of cardiac
tamponade, you should start to feel better as fluid
removal decreases the pressure on your heart. In
general, your healthcare provider is the best person to
tell you the likely recovery time and when you should
start to feel better.
Reduce my risk of developing this, or prevent
it from happening entirely:
• Pericardial effusion is unpredictable, so it’s usually
impossible to prevent it. However, you can
indirectly reduce your risk by avoiding
circumstances that could cause one to happen. Those
circumstances are:
• Letting an infection go untreated for too long.
• Engaging in risky activities, such as sports or
outdoor activities with a greater risk of injury,
without taking safety precautions like wearing
protective equipment.
• Pericardial fluid analysis is used to help diagnose
the cause of inflammation of the pericardium
(pericarditis) and/or fluid accumulation around the
heart (pericardial effusion).
• There are two main reasons for fluid accumulation:
an imbalance of pressure within blood vessels or
inflammation of the pericardium.
• An initial set of tests, including fluid protein or
albumin level, cell count, and appearance, is used to
differentiate between the two types of resulting
fluids, called transudate and exudate.
Transudate
• an imbalance between the pressure within
blood vessels (which drives fluid out of the
blood vessel) and the amount of protein in
blood (which keeps fluid in the blood vessel)
can result in accumulation of fluid.
• Transudates are most often caused by
congestive heart failure or cirrhosis. If the fluid
is determined to be a transudate, then usually
no more tests on the fluid are necessary.
Exudate—
• injury or inflammation of the pericardium may cause
abnormal collection of fluid (called an exudate).
• Exudates are associated with a variety of conditions
and diseases. If the fluid is an exudate, then several
additional tests may be ordered to help diagnose the
specific condition, which may include:
• Infectious diseases – caused by viruses, bacteria, or
fungi. Infections may originate in the pericardium or
spread there from other places in the body. For
example, pericarditis may follow a respiratory
infection or a chest cold.
• Bleeding – bleeding disorders and/or trauma can
lead to blood in the pericardial fluid.
• Inflammatory conditions – pericarditis may follow a
heart attack, radiation treatment, or be part of
autoimmune disorders such as rheumatoid arthritis
and lupus.
• Cancer – such as mesothelioma that has arisen in the
pericardium or metastatic cancer that has spread to
it.
• Test results can help distinguish between types of
pericardial fluid and help diagnose the cause of fluid
accumulation. The initial set of tests performed on a
sample of pericardial fluid helps determine whether
the fluid is a transudate or exudate.
Transudate
• Transudates are most often caused by either
congestive heart failure or cirrhosis. Typical fluid
analysis results include:
• Physical characteristics—fluid appears clear
• Protein or albumin level—low
• Cell count—few cells are present
Exudate
• Exudates can be caused by a variety of conditions
and diseases. Initial test results may show:
• Physical characteristics—fluid may appear cloudy
• Protein or albumin level—high
• Cell count—increased
• Additional test results and their associated causes
may include:
Physical characteristics
• the normal appearance of a sample of pericardial
fluid is straw-colored and clear. Abnormal results
may give clues to the conditions or diseases present
and may include:
• Milky appearance—may point to lymphatic system
involvement.
• Reddish pericardial fluid may indicate the presence
of blood.
• Cloudy, thick pericardial fluid may indicate the
presence of microorganisms and/or white blood
cells.
Chemical tests
• in addition to protein or albumin, a glucose test may be performed.
Glucose in pericardial fluid samples is typically about the same
as blood glucose levels. It may be lower with infection.
• Microscopic examination – normal pericardial fluid has small
numbers of white blood cells (WBCs) but no red blood cells
(RBCs) or microorganisms. Results of an evaluation of the
different kinds of cells present may include:
• Total cell counts—quantity of WBCs and RBCs in the sample.
Increased WBCs may be seen with infections and other causes of
pericarditis.
• WBC differential—determination of percentages of different types
of WBCs. An increased number of neutrophils may be seen with
bacterial infections.
• Cytology—a cytocentrifuged sample is treated with a special stain
and examined under a microscope for abnormal cells. This may be
done when a mesothelioma or metastatic cancer is suspected. The
presence of certain abnormal cells, such as tumor cells or immature
blood cells, can indicate what type of cancer is involved.
• Infectious disease tests – routine tests may be performed to
look for microorganisms if infection is suspected:
• Gram stain—for direct observation of bacteria or fungi under
a microscope. There should be no organisms present in
pericardial fluid.
• Bacterial culture and susceptibility testing—if bacteria are
present, susceptibility testing can be performed to guide
antimicrobial therapy. If there are no microorganisms present,
it does not rule out an infection. Bacteria may be present in
small numbers or their growth may be inhibited because of
prior antibiotic therapy.
• Adenosine deaminase—a markedly elevated level in
percardial fluid in a person with symptoms that suggest
tuberculosis means it is likely that person has
a Mycobacterium tuberculosis infection in the pericardium.
This is especially true when there is a high prevalence of
tuberculosis in the geographic region where a person lives.
• Other less common tests for infectious diseases may be
performed. Those tests may identify pericardial fluid
accumulation due to a viral infection, mycobacteria
(such as the mycobacterium that causes tuberculosis), or
a parasite.
• Sugar:
• Pericardial fluid glucose ≤ 70 mg/dl and CT attenuation
values > 20 HU were cutoff values associated with
malignancy .Additionally, pericardial fluid glucose ≤ 70
mg/dl and CT attenuation values > 20 HU were also
cutoff values associated with positive-cytology patients
• Protein:
• Exudative and transudative pericardial effusions can be
differentiated using fluid total protein concentrations >
30 g/L, fluid/serum total protein ratio > 0.5 and fluid
LD > 300 U/L.
Cell count:
• Pericardial fluid is an ultrafiltrate of plasma that lies
within the pericardial sac, acting as a lubricant between
the visceral and parietal layer of the pericardium.
• It consists of two layers, an outer fibrous layer and the
inner serous layer.
• The fluid is made up of a high concentration of lactate
dehydrogenase (LDH), protein and lymphocytes.In a
healthy adult, there is up to 50 ml of clear, straw-
coloured fluid.
• Cell Count Cell Type test is performed on a sample of
pericardial fluid to measure the level of Leukocytes and
Neutrophils in the pericardial fluid and also to detect
Pericardial Tumors and Pericarditis.
• Cell count and cell type test of the pericardial fluid doesn’t
require any particular preparation. It is important for the
physician to enquire with the patient regarding their medical
history and also ensure that the patient is not under any
medication.
• It is important for the doctor to diagnose or obtain sufficient
information from the patient that he/she are not suffering from
any kind of medical conditions or allergies before undergoing
the Cell Count and Cell Type test of the Pericardial Fluid.
• After carrying out the above analysis the doctor will give the
patient with specific instructions based on the patient's
condition. Cytologic study of pericardial fluid helps identify
malignancy as the cause of pericardial effusion by detecting
neoplastic cells within the fluid.
• However, it is not always straightforward. Nonmalignant cells
can be morphologically indistinguishable from malignant
cells. The normal result for Cell Count Cell Type Microscopy
Pericardial Fluid for Leukocytes is < 500/microlitre for
Unisex gender and for All age groups.

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Effusions pericardial.pptx

  • 2. Effusions pericardial • Pericardial effusion is an accumulation of fluid in the pericardium, the sac that holds your heart. • When it happens quickly or involves a large amount of fluid, the excess fluid can take up too much space in the pericardium, compressing your heart and causing a life-threatening condition known as cardiac tamponade. Pericardial effusion is a buildup of fluid in the space around the heart. • It can happen for a wide range of reasons, including infections, injuries or other medical conditions. If the buildup is severe or happens quickly, it can compress your heart and cause cardiac tamponade, a life-threatening medical emergency. • The pericardium is a double-walled sac that surrounds the heart. Between the inner wall of the pericardium and your heart is a thin layer of fluid, which cushions and protects your heart from outside forces (much like bubble wrap around a fragile item inside a shipping box).
  • 3. • Under normal circumstances, the pericardium has just enough fluid to cushion your heart, but not so much fluid that your heart can’t expand and fill up with blood with every heartbeat. • Cardiac tamponade happens when there’s too much fluid inside the pericardium, which means your heart has no room to expand and fill up with blood. • Without quick treatment, it can cause your heart to stop, which is eventually fatal within minutes to hours.
  • 4. Difference between pericardial effusion and pleural effusion: • Pleural effusion is similar to pericardial effusion, but it happens in a different place inside your chest. The pleural cavity is the sac that surrounds your lungs, and a pleural effusion is when fluid fills up that space. • A pleural effusion keeps your lungs from expanding as they should, which makes it harder for you to breathe. • Pericardial effusion can happen for a wide range of reasons. Because of that, it can happen to people of any age or background. • It’s also a relatively common condition. However, there’s very little data on exactly how common it is. • Sometimes, pericardial effusion is an incidental finding on an imaging test, meaning healthcare providers discover it without intending to.
  • 5. This condition affect my body: • Every heartbeat starts with a pause where your heart muscle relaxes and expands. That lets the chambers of the heart fill up with blood before they squeeze. As the pericardium fills up, there's less space for your heart to expand. Eventually, your heart doesn’t have room to expand so its chambers can fill up with blood. • An easy way to see how pericardial effusion affects your heart is by trying to blow up a balloon inside of a plastic bottle. In this example, your heart is the balloon and the bottle is the pericardium. When the bottle is empty, there's more space for the balloon to inflate. If you add water to the bottle, there's less space and you can't blow up the balloon as much. If you keep filling the bottle, eventually you can't blow up the balloon at all. • As your heart pumps less and less blood, it speeds up to try to make up for its limited pumping ability. Over time, your heart can't keep up, and you go into cardiogenic shock, which makes your heart stop. Without treatment, cardiogenic shock is deadly.
  • 6. Symptoms: • Pericardial effusions may not cause any symptoms, especially when they’re small or happen slowly. Symptoms are more likely when an effusion happens quickly, involves a large amount of fluid or causes cardiac tamponade. The main symptoms of pericardial effusions and cardiac tamponade include: • Shortness of breath (dyspnea). • Chest pressure or pain. • Fast heartbeat or heart palpitations (the unpleasant feeling of your own heartbeat without feeling for your pulse). • Lightheadedness or dizziness. • Fainting (syncope). • Fatigue. • Anxiety, confusion or other behavior changes (because of low blood flow to the brain). • Cyanosis (a blue or gray tinge to your lips or under your fingernails that happens when you have low blood oxygen levels).
  • 7. • If a pericardial effusion is large enough, it can press on surrounding tissues or nerves. That can cause symptoms like: • Trouble swallowing (dysphagia). • Hiccups. • Coughing or hoarseness.
  • 8. Causes pericardial effusion: • Pericardial effusion can happen for many different reasons. It often happens along with (or because of) inflammation of the pericardium (pericarditis). • Possible causes of pericardial effusion include: • Infections. Pericardial effusion often happens because of viral or bacterial infections, including human immunodeficiency virus (HIV) and tuberculosis (though this is less common in developed countries). It can also happen because of fungal infections or parasites. • Cancer. Tumors in the heart or that spread from elsewhere in your body can cause damage to the pericardium.
  • 9. • Immune system conditions or inflammatory disorders. These include lupus, rheumatoid arthritis or Sjögren’s syndrome. • Hormonal disorders or problems. An example of this is hypothyroidism (where your thyroid gland isn’t producing enough thyroid hormone). • Trauma. Injuries to the chest, including blunt impacts (like car crashes) and punctures from knives or bullets, can cause pericardial effusion. • Heart or circulatory problems. These include heart attacks or aortic dissection (where layers on the inside of your aorta separate or tear). • Medical causes. Pericardial effusion can happen after heart surgery, radiation therapy for cancer or as a side effect of some medications. • Other. Pericardial effusion can also happen with heart failure, chronic kidney disease or kidney failure, liver cirrhosis or for unknown reasons.
  • 10. Pericardial effusion always a serious problem: • Pericardial effusion is usually a significant condition, but it isn’t always a medical emergency. • Pericardial effusions may be small or large, and sometimes smaller effusions go away on their own. • Whether or not it’s a life-threatening emergency depends on what caused it, the amount of fluid involved, and how fast that fluid fills the pericardium. • When an effusion happens quickly, it needs less fluid to become dangerous and cause cardiac tamponade.
  • 11. • That's because the pericardium doesn't have time to stretch and expand to accommodate more fluid inside it. • When a pericardial effusion happens slowly, it can take weeks or even months before it becomes a problem. • One factor that determines if a pericardial effusion is serious is why it happened in the first place. • When it happens because of injuries or heart and circulatory problems (or any reason that can cause an effusion to develop quickly), pericardial effusion needs quick treatment to avoid dangerous complications like cardiac tamponade.
  • 12.
  • 13. Pericardial effusion diagnosed: • If you have symptoms, a doctor will diagnose pericardial effusion based on a combination of the symptoms you describe, your medical history, medical testing, and examining you for any signs and symptoms of this condition. Some of the key signs include an unusual drop in your blood pressure when you breathe in, muffled or unusual heart sounds, or bulging of the jugular vein in your neck. • If you don’t have symptoms, the most likely way a doctor will diagnose pericardial effusion is if they happen to see it on medical imaging for another reason. This kind of diagnosis is called an incidental finding, and an example of this is a pericardial effusion that’s visible on a chest X-ray after a car accident. • A wide range of tests is possible when healthcare providers evaluate your symptoms or suspect a pericardial effusion.
  • 14. Imaging tests • Echocardiogram. • Chest x-ray. • Computed tomography (CT) scan of the chest. • MRI of the heart
  • 15. Electrocardiogram: • This test measures the electrical activity of your heart through a set of sensors (usually 10) called electrodes, which attach to the skin of your chest. • The electrodes detect your heart’s electrical activity and show it as a wave on either a paper printout or a screen display. • Doctors can tell when your heart isn’t beating properly because its electrical activity changes in certain ways, some of which are very distinctive.
  • 16. Lab tests • Lab tests usually come after a provider diagnoses pericardial effusion. These tests focus on finding out why you have a pericardial effusion. The possible tests include: • Complete blood count. • Troponin. • B-type natriuretic peptide. • Thyroid-stimulating hormone. • Immune system tests (to look for immune system disorders or inflammatory conditions). • In some cases, tests on the fluid taken out of your pericardium are also possible. Testing the fluid can sometimes help doctors understand the underlying cause behind the effusion
  • 17. Treated: • Pericardial effusions are often treatable. Whether or not they’re curable depends on how severe they are and why they happened. • Your healthcare provider is the best person to tell you what to expect from the treatment, including whether or not your effusion is curable. • Needle aspiration (pericardiocentesis): After numbing a specific area on your chest and using imaging tools (like echocardiography or fluoroscopy) for guidance, a healthcare provider will insert a needle into your chest until it is just inside the pericardium. They’ll then aspirate (pull out) the excess fluid inside. Sometimes, a thin, tube-like device is left inside the pericardium to drain fluid for a few days until it is all gone.
  • 18. Surgery • In some cases, surgery is the best way to remove the extra fluid inside the pericardium. Surgery can happen in an emergency, or it can be a scheduled procedure when an effusion causes symptoms but is slow-growing and not dangerous. • A common surgical procedure for this is video- assisted thoracic surgery (VATS), which creates a pericardial “window” to allow draining fluid to spill into the larger pleural cavity so it doesn’t fill up the pericardial space.
  • 19. • In cases where an effusion isn’t dangerous and doesn’t need any of the above treatments, it’s often possible to treat it with medications or other types of treatments. The treatments depend on the underlying cause. These include, but aren’t limited to, the following: • Antibiotics. These help by treating underlying infections, such as tuberculosis, which can cause pericarditis and effusions. • Anti-inflammatory drugs. These help reduce inflammation and swelling. • Chemotherapy and radiation therapy. These help when pericardial effusion happens because of cancer. • Diuretics and other heart failure medications. These help when heart failure is the cause behind a pericardial effusion.
  • 20. Potential side effects or complications to the treatments: • The possible side effects with treatments for pericardial effusion depend strongly on which treatments or medications you receive. Your healthcare provider is the best person to tell you about what side effects are possible with the medications you take because they can tailor the information to fit your specific needs and circumstances. • A possible complication is pericardial decompression syndrome when you undergo a procedure or surgery to treat a pericardial effusion. While it isn't common, it is severe and life-threatening. It usually happens when fluid removal happens too quickly from a large effusion. To avoid this, your healthcare provider may drain the effusion more slowly.
  • 21. Take care of myself/manage symptoms: • Pericardial effusion isn’t something you should try to treat on your own unless you’ve spoken with a healthcare provider. • That’s because it isn’t possible to diagnose it without specific medical tests and imaging. After getting this diagnosis, you can ask your healthcare provider what you can do to manage your symptoms and limit their impact on your life.
  • 22. After treatment will I feel better, and how long does it take to recover: • How long it takes you to feel better and recover depends on three main factors: • The cause of the effusion. • The severity of the effusion. • The treatments you received. • Your overall health and whether or not you have any other related medical conditions. • In cases where you have symptoms of cardiac tamponade, you should start to feel better as fluid removal decreases the pressure on your heart. In general, your healthcare provider is the best person to tell you the likely recovery time and when you should start to feel better.
  • 23. Reduce my risk of developing this, or prevent it from happening entirely: • Pericardial effusion is unpredictable, so it’s usually impossible to prevent it. However, you can indirectly reduce your risk by avoiding circumstances that could cause one to happen. Those circumstances are: • Letting an infection go untreated for too long. • Engaging in risky activities, such as sports or outdoor activities with a greater risk of injury, without taking safety precautions like wearing protective equipment.
  • 24. • Pericardial fluid analysis is used to help diagnose the cause of inflammation of the pericardium (pericarditis) and/or fluid accumulation around the heart (pericardial effusion). • There are two main reasons for fluid accumulation: an imbalance of pressure within blood vessels or inflammation of the pericardium. • An initial set of tests, including fluid protein or albumin level, cell count, and appearance, is used to differentiate between the two types of resulting fluids, called transudate and exudate.
  • 25. Transudate • an imbalance between the pressure within blood vessels (which drives fluid out of the blood vessel) and the amount of protein in blood (which keeps fluid in the blood vessel) can result in accumulation of fluid. • Transudates are most often caused by congestive heart failure or cirrhosis. If the fluid is determined to be a transudate, then usually no more tests on the fluid are necessary.
  • 26. Exudate— • injury or inflammation of the pericardium may cause abnormal collection of fluid (called an exudate). • Exudates are associated with a variety of conditions and diseases. If the fluid is an exudate, then several additional tests may be ordered to help diagnose the specific condition, which may include: • Infectious diseases – caused by viruses, bacteria, or fungi. Infections may originate in the pericardium or spread there from other places in the body. For example, pericarditis may follow a respiratory infection or a chest cold.
  • 27. • Bleeding – bleeding disorders and/or trauma can lead to blood in the pericardial fluid. • Inflammatory conditions – pericarditis may follow a heart attack, radiation treatment, or be part of autoimmune disorders such as rheumatoid arthritis and lupus. • Cancer – such as mesothelioma that has arisen in the pericardium or metastatic cancer that has spread to it. • Test results can help distinguish between types of pericardial fluid and help diagnose the cause of fluid accumulation. The initial set of tests performed on a sample of pericardial fluid helps determine whether the fluid is a transudate or exudate.
  • 28. Transudate • Transudates are most often caused by either congestive heart failure or cirrhosis. Typical fluid analysis results include: • Physical characteristics—fluid appears clear • Protein or albumin level—low • Cell count—few cells are present
  • 29. Exudate • Exudates can be caused by a variety of conditions and diseases. Initial test results may show: • Physical characteristics—fluid may appear cloudy • Protein or albumin level—high • Cell count—increased • Additional test results and their associated causes may include:
  • 30. Physical characteristics • the normal appearance of a sample of pericardial fluid is straw-colored and clear. Abnormal results may give clues to the conditions or diseases present and may include: • Milky appearance—may point to lymphatic system involvement. • Reddish pericardial fluid may indicate the presence of blood. • Cloudy, thick pericardial fluid may indicate the presence of microorganisms and/or white blood cells.
  • 31. Chemical tests • in addition to protein or albumin, a glucose test may be performed. Glucose in pericardial fluid samples is typically about the same as blood glucose levels. It may be lower with infection. • Microscopic examination – normal pericardial fluid has small numbers of white blood cells (WBCs) but no red blood cells (RBCs) or microorganisms. Results of an evaluation of the different kinds of cells present may include: • Total cell counts—quantity of WBCs and RBCs in the sample. Increased WBCs may be seen with infections and other causes of pericarditis. • WBC differential—determination of percentages of different types of WBCs. An increased number of neutrophils may be seen with bacterial infections. • Cytology—a cytocentrifuged sample is treated with a special stain and examined under a microscope for abnormal cells. This may be done when a mesothelioma or metastatic cancer is suspected. The presence of certain abnormal cells, such as tumor cells or immature blood cells, can indicate what type of cancer is involved.
  • 32. • Infectious disease tests – routine tests may be performed to look for microorganisms if infection is suspected: • Gram stain—for direct observation of bacteria or fungi under a microscope. There should be no organisms present in pericardial fluid. • Bacterial culture and susceptibility testing—if bacteria are present, susceptibility testing can be performed to guide antimicrobial therapy. If there are no microorganisms present, it does not rule out an infection. Bacteria may be present in small numbers or their growth may be inhibited because of prior antibiotic therapy. • Adenosine deaminase—a markedly elevated level in percardial fluid in a person with symptoms that suggest tuberculosis means it is likely that person has a Mycobacterium tuberculosis infection in the pericardium. This is especially true when there is a high prevalence of tuberculosis in the geographic region where a person lives.
  • 33. • Other less common tests for infectious diseases may be performed. Those tests may identify pericardial fluid accumulation due to a viral infection, mycobacteria (such as the mycobacterium that causes tuberculosis), or a parasite. • Sugar: • Pericardial fluid glucose ≤ 70 mg/dl and CT attenuation values > 20 HU were cutoff values associated with malignancy .Additionally, pericardial fluid glucose ≤ 70 mg/dl and CT attenuation values > 20 HU were also cutoff values associated with positive-cytology patients • Protein: • Exudative and transudative pericardial effusions can be differentiated using fluid total protein concentrations > 30 g/L, fluid/serum total protein ratio > 0.5 and fluid LD > 300 U/L.
  • 34. Cell count: • Pericardial fluid is an ultrafiltrate of plasma that lies within the pericardial sac, acting as a lubricant between the visceral and parietal layer of the pericardium. • It consists of two layers, an outer fibrous layer and the inner serous layer. • The fluid is made up of a high concentration of lactate dehydrogenase (LDH), protein and lymphocytes.In a healthy adult, there is up to 50 ml of clear, straw- coloured fluid. • Cell Count Cell Type test is performed on a sample of pericardial fluid to measure the level of Leukocytes and Neutrophils in the pericardial fluid and also to detect Pericardial Tumors and Pericarditis.
  • 35. • Cell count and cell type test of the pericardial fluid doesn’t require any particular preparation. It is important for the physician to enquire with the patient regarding their medical history and also ensure that the patient is not under any medication. • It is important for the doctor to diagnose or obtain sufficient information from the patient that he/she are not suffering from any kind of medical conditions or allergies before undergoing the Cell Count and Cell Type test of the Pericardial Fluid. • After carrying out the above analysis the doctor will give the patient with specific instructions based on the patient's condition. Cytologic study of pericardial fluid helps identify malignancy as the cause of pericardial effusion by detecting neoplastic cells within the fluid. • However, it is not always straightforward. Nonmalignant cells can be morphologically indistinguishable from malignant cells. The normal result for Cell Count Cell Type Microscopy Pericardial Fluid for Leukocytes is < 500/microlitre for Unisex gender and for All age groups.