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Ben-Horin et al. (2005) studied the composition of pericardial fluid in patients undergoing open heart surgery. They found that the fluid is made up of a high concentration of lactate dehydrogenase (LDH), protein and lymphocytes. In a healthy adult there is up to 50 ml of clear, straw-coloured fluid. [3]
A pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. The pericardium is a two-part membrane surrounding the heart: the outer fibrous connective membrane and an inner two-layered serous membrane .
This places the heart in proximity to the chest wall for easier insertion of the needle into the pericardial sac. [5] [7] For patients that are awake, a local anaesthetic is applied. [8] A large needle is inserted through the skin of the chest into the pericardium, and the practitioner aspirates the pericardial effusion into a syringe. [6]
Pulsus paradoxus is a sign that is indicative of several conditions, most commonly pericardial effusion. [ 1 ] The paradox in pulsus paradoxus is that, on physical examination , one can detect beats on cardiac auscultation during inspiration that cannot be palpated at the radial pulse . [ 1 ]
Purulent Pericarditis; Echocardiogram showing pericardial effusion with signs of cardiac tamponade: Specialty: Cardiology: Symptoms: substernal chest pain (exacerbated supine and with breathing deeply), dyspnea, fever, rigors/chills, and cardiorespiratory signs (i.e., tachycardia, friction rub, pulsus paradoxus, pericardial effusion, cardiac tamponade, pleural effusion)
Figure A shows the location of the heart and a normal heart and pericardium (the sac surrounding the heart). The inset image is an enlarged cross-section of the pericardium that shows its two layers of tissue and the fluid between the layers. Figure B shows the heart with pericarditis.
Conversely, patients with unexplained new onset cardiomegaly should always be worked up for acute pericarditis. [citation needed] An echocardiogram is typically normal in acute pericarditis but can reveal pericardial effusion, the presence of which supports the diagnosis, although its absence does not exclude the diagnosis. [citation needed]
Uremic pericarditis is associated with azotemia, and occurs in about 6-10% of kidney failure patients. BUN is normally >60 mg/dL (normal is 7–20 mg/dL). However, the degree of pericarditis does not correlate with the degree of serum BUN or creatinine elevation. The pathogenesis is poorly understood. [2]