Pericardiocentesis

Excerpt

Pericardiocentesis is a procedure designed to remove fluid from the pericardial sac for therapeutic relief or diagnostic purposes. This procedure is indicated when pericardial effusion, acute or chronic, causes significant symptoms that are often in the form of cardiac tamponade, a life-threatening condition. Additionally, it may also be indicated for acute or chronic pericardial effusions without tamponade to diagnose effusion etiology, alleviate symptoms such as dyspnea and edema, or prevent progression to tamponade. The procedure can be performed blind, but real-time imaging, such as transthoracic echocardiography or fluoroscopy, is recommended to minimize complications. The decision to perform pericardiocentesis and the approach used—whether blind or guided by real-time imaging modalities—are influenced by the etiology and characteristics of the effusion, as well as patient stability.

Pericardial fluid accumulation occurs due to increased production, impaired drainage, or both, leading to excessive fluid in the pericardial sac. This condition can result from various pathological processes, including infections, malignancies, autoimmune diseases, postmyocardial infarction syndromes, and metabolic derangements like uremia. Symptomatic effusions, especially those resulting in tamponade, require prompt intervention. This procedure remains the fastest and most effective method for fluid evacuation. While pericardiocentesis is a safe procedure in experienced hands, it remains high-risk without adequate anatomical knowledge or imaging guidance. This activity explores the indications, techniques, and considerations for optimizing outcomes in patients undergoing pericardiocentesis.