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Definition

Pericardiocentesis is a procedure that uses a needle to remove fluid from the pericardial sac, the tissue that surrounds the heart.

Alternative Names

Pericardial tap; Percutaneous pericardiocentesis

How the test is performed

The procedure is usually done in an intensive care unit's procedure room or even at the bedside.

A health care provider will put an IV into your arm in case fluids or medicines need to be given through a vein. For example, medication may be given if you have slowing of the heartbeat or a drop in blood pressure during the procedure.

The health care provider will clean an area just below the breastbone and apply a local numbing medication (anesthetic). The doctor will insert a needle and guide it into the pericardial sac. Echocardiography is used to help position the needle and monitor fluid drainage, although electrocardiographic (ECG) leads may also be used to help with positioning.

Once the needle has reached the correct area, it is removed and replaced with a tube called a catheter. Fluid drains through this catheter into containers. Usually, the pericardial catheter is left in place so draining may continue for several hours.

Surgical pericardiocentesis may be necessary in difficult cases. In this procedure, the fluid is drained through a more invasive procedure that may require anesthesia.

How to prepare for the test

You may not be able to eat or drink for 6 hours before the test. You must sign a consent form.

How the test will feel

You may feel pressure as the needle enters. Some people have chest pain, which may require pain medication.

Why the test is performed

This test may be done to remove and examine fluid that is pressing on the heart. It is usually done to evaluate the cause of a chronic or recurrent pericardial effusion.

It may also be done to treat cardiac tamponade.

Normal Values

There is normally a small amount of clear, straw-colored fluid in the pericardial space.

What abnormal results mean

Abnormal findings may indicate the cause of pericardial fluid accumulation, such as:

What the risks are
  • Bleeding
  • Collapsed lung
  • Heart attack
  • Infection (pericarditis)
  • Irregular heartbeats (arrhythmias)
  • Puncture of the heart muscle, coronary artery, lung, liver, or stomach
  • Pneumopericardium (air in the pericardial sac)
References

LeWinter MM. Pericardial diseases. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007:chap 70.

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Pericardiocentesis to test for viruses, bacteria, fungus, cancer, and tuberculosis.

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Cardiac tamponade and pericarditis are two primary complications that require intervention with pericardiocentesis.

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Pericardiocentesis is the removal by needle of pericardial fluid from the sac surrounding the heart for diagnostic or therapeutic purposes.

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Pericardiocentesis may be advisable in order to obtain a fluid sample for laboratory analysis to identify the underlying cause of the condition.

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An ultrasound test should confirm the pericardial effusion and guide the pericardiocentesis needle for the procedure. Risks include accidental puncture to arteries or organs.

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No special dietary restrictions are required for pericardiocentesis. If the test is elective, then food and water restriction is recommended for six hours before the test.

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The Cpt code for Repeat Pericardiocentesis is 33011, it's listed under subsequent. For radiological supervision and interpretation, use 76930. Hope this helps.

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Continued bleeding or abnormal swelling of the puncture site, sudden dizziness, difficulty breathing, or chest pains in the days following a pericardiocentesis.

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The procedure can be performed in an emergency room, ICU, or at the bedside

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Ah, extracting fluid from the pericardial sac is known as a pericardiocentesis. It's a delicate procedure that helps relieve pressure around the heart and allows it to function more easily. Remember, it's important to trust your healthcare team and follow their guidance every step of the way.

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A procedure performed with a needle to remove fluid for diagnostic or therapeutic purposes from the tissue covering the heart (pericardial sac).

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The term for puncturing the heart is cardiocentesis.

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  1. (medicine) Puncture and aspiration of
  2. Ex. The doctor performed a pericardiocentesis to remove the excess fluid from around the patient's heart.

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The site of the puncture and any drainage catheter should be checked regularly for signs of infection such as redness and swelling. Blood pressure and pulse are also monitored.

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In emergency situations, when fluid builds up too rapidly or excessively in the pericardial cavity, the compression on the heart impairs the pumping action, as in cardiac tamponade.

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Stethescope, a grating sound is heard; electrocardiograph; echocardiogram; x ray; computed tomography scan; heart catheterization; pericardiocentesis; blood tests.

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Because of the risk of accidental puncture to major arteries or organs in pericardiocentesis, surgical drainage may be a preferred treatment.

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It is an invasive procedure, and infection of the puncture site or pericardium is always a risk. Possible complications include perforation of a major artery, lung, liver or heart myocardium.

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It is called pericardiocentesis. This procedure involves withdrawing fluid from the pericardial sac surrounding the heart using a needle to relieve pressure or collect a sample for analysis.

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The procedure is explained and possible complications, an informed consent form signed. An intravenous line is inserted into a vein in the arm for sedation, medication and blood products. An ECG is hooked up.

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Normal pericardial fluid is clear to straw-colored in appearance with no bacteria, blood, cancer cells or pathogens. There is typically a minimal amount of the fluid (10-50 ml) in the pericardial cavity.

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The patient should sit with the head elevated 30-40 degrees. This is done to maximize fluid drainage. A site close to the pericardial sac is chosen, and if time permits the patient is sedated.

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A large volume of pericardial fluid (over 50 ml) indicates pericardial effusion. Fluid analysis can find the cause of pericarditis. The presence of blood indicates bleeding, cardiac rupture or cancer.

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Pericardiocentesis is removal of fluid from the pericardial space by means of a needle. It can be used to decrease pressure in the space caused by an excess of fluid.

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Pericardiocentesis is a procedure that involves inserting a needle through the chest wall into the pericardial sac around the heart to remove excess fluid, relieving pressure on the heart. It is used in emergency situations to treat cardiac tamponade, a condition where excessive fluid accumulation in the pericardial sac inhibits the heart's ability to pump effectively. The procedure is usually done under local anesthesia and guidance of imaging techniques like echocardiography to ensure precise placement of the needle.

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The procedure you are referring to is called pericardiocentesis. It involves inserting a needle into the sac around the heart to remove excess fluid for diagnostic or therapeutic purposes. A catheter may be left in place to continue drainage and relieve pressure on the heart.

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Relieve the pressure off the heart by removing the excess fluid or blood.

This is performed either by pericardiocentesis, which is the procedure where a large needle is inserted into the pericardium and the blood/fluid is removed. If the cause is an injury to the heart itself, this may be enough of a temporizing measure (but definitely not curative) to allow the patient to have the time to make it to the operating room with a cardiac surgeon who can repair the injury. If the patient loses vital signs in the Emergency room and is not stable enough to go to the operating room (OR), an emergency thoracotomy may need to be performed. The left chest is opened emergently and the pericardium is entered primarily in an effort to find the damage to the heart and repair it temporarily to allow the patient to go to the OR for primary repair and closure.

Unfortunately, hemopericardium and tamponade caused by primary cardiac rupture/injury is not something most will survive, and emergency thoracotomy has a survival rate of less than 5 percent (probably on the order of 1 to 2 percent survival). It really is a last-ditch effort to save someone's life, but in most cases is not successful, despite a physician's best efforts.

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Thoracotomy means surgical incision of the chest or thorax. A incision into the chest is done with two different methods. A incision into the front of the chest is known as a Median Sternotomy. This is usually the incision used for cardiac bypass, valve replacement, etc. A incision into the side of the chest is known as a Thoracotomy.

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If too much fluid (more then 200 ml) builds up in the pericardial sac, a condition called cardiac tamponade may occur. This is a condition where the fluid build up is so great that is pushes on the heart and constricts it. The heart is not able to pump hard enough to supply sufficient blood to the body.

The symptoms of cardiac tamponade include Beck's triade: Jugular vein distention (enlarged neck veins), muffled heart sounds, and narrowed pulse pressure

(systolic blood pressure, the first number in a blood pressure, decreases, while diastolic blood pressure, the second number, increases). If not treated the patient will eventually go into shock because the heart cannot pump effectively.

In this case the physician must perform a pericardiocentesis, in which he or she inserts a syringe into the pericardial sac and draws off the extra fluid.

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Definition

Cardiac tamponade is compression of the heart that occurs when blood or fluid builds up in the space between the myocardium (heart muscle) and the pericardium (outer covering sac of the heart).

Alternative Names

Tamponade; Pericardial tamponade

Causes, incidence, and risk factors

In this condition, blood or fluid collects in the pericardium. This prevents the ventricles from expanding fully. The excess pressure from the fluid prevents the heart from functioning normally.

Cardiac tamponade can occur due to:

Other potential causes include:

Cardiac tamponade occurs in approximately 2 out of 10,000 people.

Symptoms
  • Anxiety, restlessness
  • Chest pain
    • Radiating to the neck, shoulder, back, or abdomen
    • Sharp, stabbing
    • Worsened by deep breathing or coughing
  • Difficulty breathing
  • Discomfort, sometimes relieved by sitting upright or leaning forward
  • Fainting, light-headedness
  • Pale, gray, or blue skin
  • Palpitations
  • Rapid breathing
  • Swelling of the abdomen or other areas

Other symptoms that may occur with this disorder:

Signs and tests

There are no specific laboratory tests that diagnose tamponade. Echocardiogram is typically used to help establish the diagnosis.

Signs:

  • Blood pressure may fall (pulsus paradoxical) when the person inhales deeply
  • Breathing may be rapid (faster than 12 breaths in an adult per minute)
  • Heart rate may be over 100 (normal is 60 to 100 beats per minute)
  • Heart sounds are faint during examination with a stethoscope
  • Neck veins may be abnormally extended (distended) but the blood pressure may be low
  • Peripheralpulses may be weak or absent

Other tests may include:

Treatment

Cardiac tamponade is an emergency condition that requires hospitalization.

The fluid around the heart must be drained. Pericardiocentesis is a procedure that uses a needle to remove fluid from the pericardial sac, the tissue that surrounds the heart.

A procedure to cut and remove part of the pericardium (surgical pericardiectomy or pericardial window) may also be done.

Fluids are given to maintain normal blood pressure until pericardiocentesis can be performed. Medications that increase blood pressure may also help sustain the patient's life until the fluid is drained.

The patient may be given oxygen. This reduces the workload on the heart by decreasing tissue demands for blood flow.

The cause of the tamponade must be identified and treated.

Expectations (prognosis)

Tamponade is life-threatening if untreated. The outcome is often good if the condition is treated promptly, but tamponade may come back.

ComplicationsCalling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if symptoms develop. Cardiac tamponade is an emergency condition requiring immediate attention.

Prevention

Many cases are not preventable. Awareness of your personal risk factors may allow early diagnosis and treatment.

References

Jacob R, Grimm RA. Pericardial disease. In: Carey WD, ed. Cleveland Clinic: Current Clinical Medicine. 1st ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 23.

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There are two terms that are puncturing of the abdominal cavity to remove fluid, paracentesis and abdominocentesis. Of these, paracentesis is more commonly used. It can be used to remove excess fluid from the abdomen. This excess fluid is called ascites. Performed usually with ultrasound and local anaesthetic, and often the fluid drained off is sent to a laboratory for testing.

There are also specialized terms used if you are talking about draining specific areas, such as culdocentesis.

Celiocentesis is the term used in veterinary medicine for this procedure.

Abdominocentesis

Paracentesis (para = beside + centesis = puncture) is also known as peritoneocentesis and laparocentesis. The abdominal wall is punctured and fluid is removed. It is used to relieve the pressure of ascites, to diagnose infections or cancer, and to confirm free blood in the abdominal cavity.

Abdominocentesis (abdomin = belly + centesis = puncture) is also known as paracentesis, peritoneocentesis and laparocentesis. The abdominal wall (peritoneal cavity) is punctured by a needle and peritoneal fluid is withdrawn.

This can be used to relieve abdominal pressure from ascites, diagnose infectious agents, cancer or free blood in the peritoneal space.

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Definition

Bacterial pericarditis is irritation and swelling of the sac that surrounds the heart (pericardium), due to infection by bacteria.

See also: Pericarditis

Alternative Names

Purulent pericarditis

Causes, incidence, and risk factors

Bacterial infections are one cause of pericarditis. The bacterial infection causes the pericardium to become swollen and inflamed. Pain occurs as a result of the inflamed pericardium rubbing against the heart. Fluid may build up in the pericardial sac.

The most common bacteria that cause this condition are:

  • Haemophilus influenza (also called H. flu)
  • Meningococci
  • Pneumococci
  • Staphylococci
  • Streptococci

Since the introduction of antibiotics, bacterial pericarditis has become rare.

Pericarditis most often occurs in men between the ages of 20 and 50, usually after some type of respiratory infection. It can also occur after heart surgery or skin or mouth infections that produce bacterial infection of the blood (bacteremia).

Symptoms
  • Chest pain
  • May move (radiate) to the neck, shoulder, back, or abdomen
  • Pain increases with breathing
  • Sharp, stabbing
  • Sitting up or standing relieves pain
  • Chills
  • Difficulty breathing
  • Dry cough
  • Fatigue
  • Fever
  • Splinting of ribs with deep breathing (bend over and hold chest when breathing)
  • Sweating
Signs and tests

Signs include:

Doctors may suspect pericarditis when one of the following tests shows an abnormal amount of fluid in the pericardial sac:

This condition is diagnosed when the fluid around the pericardial sac is shown to be infected with bacteria. The following tests help doctors make this diagnosis:

Treatment

The goal of treatment is to cure the infection.

Medications include:

  • Antibiotics to treat bacterial infections
  • Analgesics to relieve pain
  • Aspirin, ibuprofen, or other nonsteroidal anti-inflammatory medications (NSAIDS) to relieve inflammation of the pericardium
  • Diuretics to remove excess fluid

Bedrest with the head of the bed raised may reduce the workload on the heart.

Other treatments include:

  • Cutting a small hole (window) in the pericardium (subxiphoid pericardiotomy) to allow infected fluid to drain
  • Draining fluid from the pericardial sac (pericardiocentesis) to prevent or treat cardiac tamponade
  • Pericardial stripping or removing part of the pericardium (surgical pericardiectomy) if bacterial pericarditis is chronic or comes back
Expectations (prognosis)

The disorder may be life-threatening if untreated. The outcome is good if bacterial pericarditis is treated promptly. Most people recover completely with treatment.

ComplicationsReferences

LeWinter MM. Pericardial diseases. In: Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 70.

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Definition

Pericarditis is a condition in which the sac-like covering around the heart (pericardium) becomes inflamed.

See also: Bacterial pericarditis

Causes, incidence, and risk factors

Pericarditis is usually a complication of viral infections, most commonly echovirus or coxsackie virus. Less frequently, it is caused by influenza or HIV infection.

Infections with bacteria can lead to bacterial pericarditis (also called purulent pericarditis). Some fungal infections can also produce pericarditis.

In addition, pericarditis can be associated with diseases such as:

Other causes include:

  • Heart attack (see post-MI pericarditis)
  • Injury (including surgery) or trauma to the chest, esophagus, or heart
  • Medications that suppress the immune system
  • Myocarditis
  • Radiation therapy to the chest

Often the cause of pericarditis remains unknown. In this case, the condition is called idiopathic pericarditis.

Pericarditis most often affects men aged 20 - 50. It usually follows respiratoryinfections. In children, it is most commonly caused by adenovirus or coxsackie virus.

SymptomsSigns and tests

When listening to the heart with a stethoscope, the health care provider can hear a sound called a pericardial rub. The heart sounds may be muffled or distant. There may be other signs of fluid in the pericardium (pericardial effusion).

If the disorder is severe, there may be:

If fluid has built up in the pericardial sac, it may show on:

These tests show:

Other findings vary depending on the cause of pericarditis.

To rule out heart attack, the health care provider may order serial cardiac marker levels (CPK-MB and troponin I). Other laboratory tests may include:

Treatment

The cause of pericarditis must be identified, if possible.

Medications include:

  • Analgesics for pain
  • Antibiotics for bacterial pericarditis
  • Antifungal medications for fungal pericarditis
  • Aspirin or a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen for inflammation of the pericardium
  • Corticosteroids such as prednisone (in some patients)
  • Colchicine

If the buildup of fluid in the pericardium makes the heart function poorly or produces cardiac tamponade, it is necessary to drain the fluid from the sac. This procedure, called pericardiocentesis, may be done using an echocardiography-guided needle or minor surgery.

If the pericarditis is chronic, recurrent, or causes constrictive pericarditis, cutting or removing part of the pericardium may be recommended.

Expectations (prognosis)

Pericarditis can range from mild cases that get better on their own to life-threatening cases. The condition can be complicated by significant fluid buildup around the heart and poor heart function.

The outcome is good if the disorder is treated promptly. Most people recover in 2 weeks to 3 months. However, pericarditis may come back.

ComplicationsCalling your health care provider

Call your health care provider if you experience the symptoms of pericarditis. This disorder can be life threatening if untreated.

Prevention

Many cases are not preventable.

References

LeWinter MM. Pericardial diseases. In: Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 70.

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Cardiac tamponade is a condition caused by rapid buildup of fluid (usually blood, but some conditions cause other fluids to collect) in the pericardial sac (see question below for definition of pericardium).

Small amounts of fluid or fluid that accumulates over a long period of time does not cause problems, but when the fluid volume becomes too high or it accumulates rapidly, the pressure within the pericardium rises and may eventually lead to compression of the cardiac chambers, restricting filling and emptying. This is most prominent in the right sided chambers, specifically the right atrium and ventricle. Restriction of filling results in a decrease in cardiac output and eventually hypotension, shock, and (if uncorrected) death. This is a not uncommon cause of PEA (pulseless electrical activity) in traumatically injured patients.

Signs and symptoms of cardiac tamponade include the classic signs of hypotension/shock, jugular venous distention and muffled heart sounds. Together, these signs bear the eponym "Beck's triad." Not all patients with cardiac tamponade will have all of these signs, however. Clinical suspicion in the appropriate setting still plays a major role in diagnosis. Other signs include those caused by these three core signs - altered mental status, weak or absent peripheral pulses, cyanosis, respiratory distress or failure, diaphoresis, tachycardia as the heart tries to compensate for a decreased output and hypotension, decreased urine output, and others.

Diagnosis of cardiac tamponade is done either on appropriate clinical suspicion in appropriate patients and physical exam or by ultrasound at the bedside. Rapid bedside ultrasound will reveal a large pericardial effusion with compression of the R heart structures, particularly in diastole. This is diagnostic of cardiac tamponade.

Treatment includes pericardiocentesis at bedside, either blindly or ultrasound guided or emergent pericardial window in the OR. In traumatic cases, particularly penetrating trauma, the cause is an atrial or ventricular injury or proximal aortic injury and these treatments will cause only temporary improvement with worsening again upon reaccumulation of blood. In this case, the treatment is thoracotomy and primary repair of the cardiac injury. Emergency thoractomy may be performed in the emergency department as a temporizing measure to give the patient time to make it to the OR when vital signs are lost, but overall mortality is high.

See the related questions for more information.

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The horse's heart works basically the same as ours. Four chambers and valves between them. We are not that different at that level - humans and horses are both mammals and all mammals have similar hearts.

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Definition

Pericarditis is inflammation and swelling of the covering of the heart (pericardium). The condition can occur in the days or weeks following a heart attack.

See also: Bacterial pericarditis

Alternative Names

Dressler syndrome; Post-MI pericarditis; Post-cardiac injury syndrome; Postcardiotomy pericarditis

Causes, incidence, and risk factors

Pericarditis may occur within 2 to 5 days after a heart attack, or it may occur as much as 11 weeks later. The condition is called Dressler's syndrome when it persists for weeks or months after a heart attack.

Pericarditis that occurs shortly after a heart attack is caused by an overactive response by the body's immune system. When the body senses blood in the pericardial sac or dead or severely damaged heart tissue (as with a heart attack), it triggers an inflammatory response. Cells from the immune system try to clean up the heart after injury, but, in some cases, the cells can attack healthy tissue by mistake.

Pain occurs when the pericardium becomes inflamed (swollen) and rubs on the heart.

You have a higher risk of pericarditis if you have had a previous heart attack, open heart surgery, or chest trauma.

SymptomsSigns and tests

The health care provider will use a stethoscope to listen to the heart and lungs. There may be a rubbing sound (not to be confused with a murmur), and heart sounds in general may be weak or sound far away.

Buildup of fluid in the covering of the heart or space around the lungs (pleural effusion) is not common after heart attack. But, it does occur in some patients with Dressler's syndrome.

Tests may include:

Treatment

The goal of treatment is to make the heart work better and reduce pain and other symptoms.

Nonsteroidal anti-inflammatory medications (NSAIDs) and aspirin may be used to treat inflammation of the pericardium. In extreme cases, when other medicines don't work, steroids or colchicine may be used.

In some cases, excess fluid surrounding the heart may need to be removed. This is done with a procedure calledpericardiocentesis. If complications develop, part of the pericardium may need to be removed with surgery (pericardiectomy).

Expectations (prognosis)

The condition may come back even in those who receive treatment. However, untreated pericarditis can be life threatening.

ComplicationsCalling your health care provider

Call your health care provider if you develop symptoms of pericarditis following a heart attack.

Call your health care provider if pericarditis has been diagnosed and symptoms continue or come back, despite treatment.

ReferencesLeWinter MM. Pericardial Diseases. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa; Saunders Elsevier; 2007: chap 70.

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