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Pericardial effusion

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).
1

Guidelines

1.Classification and risk stratification

Risk stratification: search for independent predictors of an identifiable and treatable cause of pericarditis, such as bacterial, neoplastic, or systemic inflammatory diseases.
B
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2.Diagnostic investigations

Initial evaluation: 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
B

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  • Echocardiography

  • Chest radiographs

  • Inflammatory markers

3.Medical management

Setting of care: 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).
B

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  • Medical therapy

4.Surgical interventions

Indications for pericardiocentesis: 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.
B

5.Specific circumstances

Patients with hemopericardium: obtain urgent TTE or CT in patients with a history of chest trauma and systemic arterial hypotension.
B
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  • Patients with neoplastic pericardial effusion

  • Patients with chylopericardium

  • Patients with neoplastic pericardial disease