Guideline 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 Show 3 more 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 https://web.pathway.md/diseases/rec3U7usGBT3fu8nj 1/3 6/29/23, 11:03 PM Pericardial effusion Pathway ECG CXR TTE. B Echocardiography: perform TTE in all patients with suspected pericardial effusion. B Chest radiographs: obtain a CXR in patients with a suspicion of pericardial effusion or pleuropulmonary involvement. B Inflammatory markers: obtain markers of inflammation, such as CRP, in patients with pericardial effusion. B 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 Medical therapy: administer aspirin/NSAIDs when pericardial effusion is associated with systemic inflammation. B Show 2 more 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 Show 3 more Patients with neoplastic pericardial effusion: perform pericardiocentesis to relieve symptoms and establish the diagnosis of malignant pericardial effusion if cardiac tamponade is present. B Show 7 more Patients with chylopericardium: diagnose chylopericardium in the presence of a milky opalescent pericardial effusion, with a triglyceride level > 500 mg/dL, cholesterol:triglyceride ratio < 1, negative cultures and lymphocyte predominance. B Patients with neoplastic pericardial disease: conduct cytological analyses of pericardial fluid to confirm malignant pericardial disease. B Clinical findings https://web.pathway.md/diseases/rec3U7usGBT3fu8nj 2/3 6/29/23, 11:03 PM Pericardial effusion Pathway Symptoms Past medical history Arm swelling Autoimmune disorders Chest pain Cancer Discomfort Injury Dizziness Medications Fainting Radiation therapy for previous cancer Leg swelling Lightheadedness Vascular exam Low urine output Nausea Neck veins distended Nausea and vomiting Respiratory exam RUQ pain Shortness of breath Ewart's sign Weakness Integument exam Vital signs Pale skin Tachycardia Tachypnea Cardiac exam Pericarditis Abdominal exam Auenbrugger's sign Lab findings Hyperuricemia References 1. Adler Y, Charron P, Imazio M et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology ESC Endorsed by: The European Association for Cardio-Thoracic Surgery EACTS . Eur Heart J. 2015 Nov 7;36 42 2921 2964. Open 2. C R Gibbs, R D Watson, S P Singh et al. Management of pericardial effusion by drainage: a survey of 10 years' experience in a city centre general hospital serving a multiracial population. Postgrad Med J. 2000 Dec;76 902 809 13. Open https://web.pathway.md/diseases/rec3U7usGBT3fu8nj 3/3