Pericardial effusion

Abitha.M1, V. Gayathri Devi2, S. J. Sonya mercy anbu3, R. Ruby4

1Staff nurse –PICU, Kauvery Hospital, Maa Kauvery, Trichy, Tamil Nadu

2Supervisor – PICU, Kauvery Hospital, Maa Kauvery, Trichy, Tamil Nadu

3Nurse educator, Kauvery Hospital, Maa Kauvery, Trichy, Tamil Nadu

4Senior DNS, Kauvery Hospital, Maa Kauvery, Trichy, Tamil Nadu

Abstract

A 12-year-old male child admitted with the complaints of fever for 1 month (intermittent low grade fever) and H/O decreased activity for 1 month associated with weight loss & poor oral intake.

Outside blood investigation showed low hemoglobin, normal total count & positive CRP, widal and dengue serology negative.

Clinical Findings

  1. Child febrile, bilateral brachial & radial pulse present
  2. Lower limb pulse volume good
  3. Left supraclavicular lymph node palpable
  4. Pallor present
  5. No significant generalized lymph adenopathy
  6. No pedal edema

Past Medical and Surgical History

Nil Significant

Antenatal & Birth History

Term/ LSCS/ Birth Weight 3.7Kg/ No NICU Stay

Family History

H/O Sputum Positive, Pulmonary TB one year back. Took ATT for 6 Months. Now symptom free

Developmental History

  1. Going to school
  2. Scholastic performance is good

Immunization History

Immunized till date.

Investigation

Investigations16/04/202517/04/202520/04/2025
Haemoglobin9.811.5
Packed cell volume23.939.2
Platelet322000302000
WBC Count78005240
ESR120
SGOT2126
SGPT1215
Albumin2.95
Urea10
Creatinine0.48
Uric acid4.24
Ferritin64.84
CRP51.54

Peripheral smear

Impression: Microcytic Hypochromic Anemia with mild reactive thrombocytosis

Pericardial Fluid

LDH: 212

ADA: 49.68

Sugar: 53

Protein: 6.80

Other

ANA profile (ANCA-P, ANCA-C) – Negative

Quantiferon TB gold IGRA – Negative

CBNAAT (Pericardial Fluid) – Negative

CBNAAT (Gastric Lavage) – Negative

Mantoux Test – Negative

ECHO

Large pericardial effusion with impending tamponade (advised elective pericardiocentesis)

Chest x-ray: Pericardal Effusion

CT -Thoracic Angiography

Smooth circumferential wall thickening with luminal narrowing in bilateral subclavian arteries (possibility of Takayasu arteritis)

Bilateral mild pleural effusion with moderate pericardial effusion? Koch’s etiology/autoimmune etiology

Management

  • Child received in hospital with chronic h/o fever, weight loss, and decreased physical activity. Child is hemodynamically stable, alert, active e& afebrile
  • On systemic examination: Muffled heart sounds with reduced air entry over left side
  • Oxygen started via face mask and IV fluids & other supportive measures.
  • Elective pericardiocentesis done after cardiac pocus. Initially 500 ml pericardial fluid drained and gradually decrease pericardial effusion in 24 hr.
  • CT Thoracic Angiography was done. Takayasu arteritis with tuberculosis was considered hence started on ATT, Pyridoxine & oral steroids.
  • Child symptomatically improved well, pericardial fluid gradually reduced and drain removed.
  • Explained child condition regarding nature of disease, risk of progression of vessel involvement, second line immunotherapy & need for revascularization.

Treatment Given

MedicationDoseRoute
Inj. ceftriaxone2 gIV
Inj. dexamethasone4 mgIV
Inj. pantocid40 mgIV
Tab.akt4(isoniazid, ethambutol ,pyrazinamide, rifampicin)Each 1tabletOral
Tab. pyridoxine10 MgOral

Nursing Management

  • Monitored patient’s vital signs
  • Maintained  intake output chart
  • Followed Fluid management strictly
  • Administered Oxygen
  • Promoted  sleep deprivation
  • Encouraged ambulation
  • Pain managed with analgesics
  • 2 hourly positioning done

Health Education

  • Advised the parents
  • To restrict child’s movements
  • To give medication correctly
  • To watch for breathing difficulty or chest pain
  • To follow up appointments with the pediatric cardiologist
  • To follow a healthy diet pattern (High protein & High calorie) and hydration status
  • To avoid strenuous activities.

Discussion

Definition

Pericardial effusion means there is extra fluid around the heart, in the sac called the pericardium. Normally, only a small amount of fluid is there to help the heart move easily. But when there is too much fluid, it can press on the heart and effect how it works.

Causes

  • Infection (such as viral or bacterial)
  • Inflammatory diseases (Like lupus)
  • Heart surgery or trauma
  • Cancer (rare in children)
  • Kidney disease or other underlying conditions

Signs and Symptoms

  • Chest pain and discomfort
  • Trouble breathing, especially when lying down
  • Tiredness or weakness
  • Tachycardia
  • Fever (if due to infection)
  • Abdomen distension, swollen legs

Diagnostic methods

  1. Echocardiography
  2. Chest X-ray
  3. CT and MRI Scan
  4. Pericardiocentesis
  5. ECG(Electrocardiogram)
  6. Blood investigations
  7. Right heart catheterization

Management

Watchful Waiting

Small effusions, especially those without symptoms or tamponade, may be monitored with echocardiogram.

Medications

  • NSAIDsand aspirin: Used to reduce inflammation of the pericardium, especially in case of Pericarditis
  • Colchicine:May be used for acute pericarditis or to prevent recurrences.
  • Corticosteroids:May be used in some cases, but potential for exacerbating pericarditis should be considered

Antibiotics: Used if the effusion is due to bacterial infection.

3. Fluid Drainage

  • Pericardiocentesis: A needle is used to drain fluid, often for diagnostic and therapeutic purposes.
  • Percutaneous Balloon Pericardiotomy: A catheter-guided procedure that creates a small hole in the pericardium to facilitate drainage.
  • Surgical Drainage (Pericardiotomy/Pericardiostomy):May be necessary for purulent or neoplastic effusions or when pericardiocentesis is not sufficient.

4. Hemodynamic Support

May be needed in case of cardiac tamponade, including fluids and medications to support blood pressure and heart function.

5. Addressing Underlying Cause

Treatment of the underlying disease (e.g., infection, cancer) is crucial.

Important Considerations

1. Cardiac Tamponade

Immediate pericardiocentesis or surgical drainage is crucial in cases of cardiac tamponade (pressure on the heart).

2. Pericardial Decompression Syndrome (PDS)

A rare but potentially life-threatening complication of rapid pericardial fluid drainage. Careful monitoring of patients after drainage, especially those with large malignant effusions, is essential.

3. Recurrent Effusions

May require further drainage procedures, indwelling catheters, or sclerosing agents.

4, Exercise Restriction

May be recommended in some cases

  • Monitoring

Regular echocardiograms and other tests may be needed to monitor the effusion and heart function.

  • Prevention

Can pericardial effusion be prevented?

Pericardial effusion is unpredictable, so usually can’t prevent it. But can indirectly reduce risk by avoiding circumstances that could cause it, like:

  • Letting an infection go untreated for too long.
  • Engaging in sports or outdoor activities that have a greater risk of injury without taking safety precautions like wearing protective equipment.

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