Pericardial fluid Analysis

Sample for Pericardial fluid Analysis

• Pericardial fluid is aspirated and tested.

Indications for pericardial fluid analysis

1. Pericardiocentesis is done to find the unexplained pericardial effusion.
2. Pericardiocentesis is advised to relieve intrapericardial pressure.
3. To diagnose acute pericarditis and pericardial effusion.
4. To diagnose acute rheumatic fever.
5. To diagnose bacterial infections.

Contraindication of pericardiocentesis

1. Avoid in uncooperative patients because there may be some damage to the coronary artery or epicardium.
2. Avoid in patients who have a bleeding disorder.

Possible complications of pericardiocentesis

1. There may be a laceration of the coronary artery or myocardium.
2. This procedure may lead to acute myocardial infarction.
3. This procedure may lead to needle-induced ventricular arrhythmia.
4. There may be vasovagal hypotension or cardiac arrest.
5. The needle may need for pleural or pericardial infection.
6. The needle may cause pneumothorax by mistake.
7. The needle may cause lacerations of the liver.

Definition of pericardial fluid

1. The pericardial cavity is formed by two thin membranes that surround the heart.
2. These membranes are separated by a fluid-containing space called the pericardial cavity.
3. Pericardial fluid is secreted by the mesothelial cells, and it will lubricate the membranes that line the pericardial cavity.

Pericardial fluid Analysis: Pericardial sac and pericardial fluid

Pathophysiology of Pericardial fluid

1. Normally there is 10 to 50 mL of pericardial fluid (another reference: 15 to 20 mL) between the pericardial serous membrane.
2. This pericardial fluid formation is due to a change in the membrane’s permeability, possibly due to infection (pericarditis), malignancy, injury, and metabolic disorders like uremia.

The function of the pericardial fluid:

1. It will allow the heart to move easily during contraction and relaxation.
2. Pericardial fluid lubricate the membranes.
3. It enables the membranes to slide over one another with minimal friction as the heart beats.

Pericardiocentesis:

1. It removes fluid from the pericardial sac, which may be therapeutic or diagnostic.
2. Pericardiocentesis procedure improves diastolic filling.
   1. It is advised as a therapeutic emergency procedure in the case of cardiac tamponade to diagnose the cause of fluid accumulation.
   2. Purpose of the pericardiocentesis:
      1. It will remove the fluid from the pericardial cavity to relieve the tamponade.
      2. Through this procedure, can administer drugs.
      3. The fluid was removed for diagnostic purposes.

Causes and classification of pericardial fluid:

1. Inflammation causes pericardial fluid accumulation, and there are other causes as well.
2. The pericardial effusion may be classified as:
   1. Serous type of fluid seen in congestive heart failure and hypoalbuminemia.
   2. The chylous type is seen in mediastinal lymphatic obstruction
   3. Serosangineous type is seen due to trauma and malignant tumors.

Signs and symptoms of pericardial effusion:

1. These patients are usually symptomatic.
2. Sometimes the large volume of the fluid is accommodated without any symptoms when it accumulates slowly.
3. When there is a massive accumulation of fluid, that may lead to cardiac tamponade.

Normal pericardial fluid:

1. Appearance = Clear or straw-colored
2. Bacteria = Negative
3. WBCs = No WBCs are seen.
4. Glucose = Equal to serum level.

Causes of Pericardial effusion:

1. Active rheumatic fever in 40% of the patients.
2. In 20% of cases, a bacterial infection is due to tuberculosis, streptococcus pneumonia, staphylococci, and gram-negative bacteria.
3. Other infections like Coxsackievirus rickettsia, parasites, and fungi.
4. Uremia may be the cause in 11% of the cases.
5. Benign nonspecific pericarditis.
6. Collagen diseases like SLE (2% of the cases).
7. Trauma.
8. Myxedema.
9. Malignant diseases (3.5% of the patient).
10. Rarely caused by severe anemia, scleroderma, polyarteritis nodosa, Wegner granulomatosis, rheumatoid arthritis, radiation, and mycotic infections.

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