Cardiac tamponade — the causes and the drainage

The causes (the systematic list): This patient's uraemia is one cause. The full list: the malignancy (lung, breast, lymphoma — commonest large effusion); the uraemia; the pericarditis (idiopathic, viral); the post-MI (the early free-wall rupture, the late Dressler); the iatrogenic (post-surgery, post-catheter, post-pacing, post-central-line, radiation); the trauma (penetrating haemopericardium); the infection (bacterial, TB, viral); the autoimmune (SLE, rheumatoid, scleroderma); the aortic dissection rupture; the hypothyroidism; the drugs (hydralazine, procainamide, isoniazid); and the idiopathic.

The technique of the pericardiocentesis (echo-guided, drain left in situ):^[4]

• The echo-guided approach (the subxiphoid, the apical, or the parasternal), with the needle advanced under the real-time ultrasound to the point of the maximal effusion.
• The aspiration of the fluid, the confirmation by the echo (the saline bubble may confirm the intrapericardial position).
• The drain left in situ (the Seldinger technique over the wire).
• The fluid sent for the cytology, the culture, the biochemistry (the protein, the LDH, the glucose).

^[4]The complications: the puncture of the right ventricle or the left ventricle (the commonest, the echo guidance reduces it); the coronary or the internal mammary laceration; the pneumothorax; the bleeding; the infection; the arrhythmia; and the recurrence (especially the malignant and the uraemic effusion, which may need the surgical window).