Pericardial effusion

Updated November 19, 2024

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of pericardial effusion are prepared by our editorial team based on guidelines from the European Society of Cardiology (ESC/EACTS 2015).

Classification and risk stratification

Risk stratification: as per EACTS/ESC 2015 guidelines, search for independent predictors of an identifiable and treatable cause of pericarditis, such as bacterial, neoplastic, or systemic inflammatory diseases.

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Diagnostic investigations

Initial evaluation: as per EACTS/ESC 2015 guidelines, obtain the following in patients with suspected pericardial disease:

auscultation

WBC count with differential

CRP and/or ESR

renal function and liver tests

cardiac biomarkers

ECG

CXR

TTE.

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Medical management

Setting of care: as per EACTS/ESC 2015 guidelines, admit patients with pericardial effusion who are at high risk (e.g., cardiac tamponade, pericardial effusion > 20 mm in diastole, fever, subacute course, failure of aspirin or NSAIDs, myopericarditis, immunosuppression, trauma, OAC therapy).

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Surgical interventions

Indications for pericardiocentesis: as per EACTS/ESC 2015 guidelines, perform pericardiocentesis or cardiac surgery in patients with cardiac tamponade, symptomatic moderate to large pericardial effusions not responsive to medical therapy, or for suspicion of an unknown bacterial or neoplastic etiology.

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Specific circumstances

Patients with hemopericardium: as per EACTS/ESC 2015 guidelines, obtain urgent TTE or CT in patients with a history of chest trauma and systemic arterial hypotension.

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