Pericardial fluid

It is fluid which is present
in the pericardial cavity of
heart b/w parietal pericardium n visceral pericardium.
The pericardial cavity is a
potential space lined by
mesothelium of the visceral n parietal pericardium.

1. Pericardial fluid Ms Ankita R Bhatiya Assistant Professor Shree P.M.Patel COLLEGE OF PARAMEDICAL SCIENCE N TECHNOLOGY

2. Pericardial fluid It include: 1.What is Pericardial fluid? 2.Function of Pericardial fluid. 3.Collection of Pericardial fluid. 4. Examination of Pericardial fluid.

3. Pericardial fluid Introduction: It is fluid which is present in the pericardial cavity of heart b/w parietal pericardium n visceral pericardium. The pericardial cavity is a potential space lined by mesothelium of the visceral n parietal pericardium. Pericarial fluid Formation: Pericardial fluid is a selective ultra filtrate of plasma. Small amount of the Pericardium fluid is also formed from the cells lining the pericardium and other by capillaries. There is about 10-60 ml of pericardium fluid at any one time and about 125 ml is generated every day.

4. Pericardial fluid Composition of Pericardial fluid: Volume: 60-70 ml Cell/mm 3 : 1000-3000 Monocyte:30 % Lymphocyte: 5% Neutrophil : 5% Protein: up to 3 gm/dl Glucose: Same as plasma LDH:70-140 U/L

5. Pericardial fluid Function of Pericardial fluid: Protection: It helps to protect the heart from the sudden injury n damaged. Also acts as a medium for the transfer of substances from the heart tissue to blood . Nutrition : Removal of waste : Lubrication :

6. Pericardial fluid Collection of Pericardial fluid: Peracardiocentesis is a process by which pericardial fluid is collected. A needle is placed through the skin and muscles of the chest wall into the pericardial space.

7. Pericardial fluid Indication of Pericardial fluid : 1.Infections: Tuberculosis, Pericardiatis (Bacterial, viral, fungal), HIV infected patient 2. Neoplasm: Metastatic carcinoma, Lymphoma. 3. Myocardial infract 4.Hemorrhage: Trauma Anticoagulated therahy Leakage of aortic 5. Metabolic disorder: Uremia Myxodema 6. Rheumatoid disease 7. Systemic lupus erythreomatous 8.Radiation theraphy 9. Hypothyrodism

8. Pericardial fluid Procedure: 1.Take consent of a patient. 2.Position of patient: The patient is sitting in an upright position with arms & head extended to over bed table. 3.Proper aseptic precautions are taken with the help of spirit –iodine-spirit. 4.Before puncture give injection of atrophin intramuscularly to prevent vasovagal shock. 5.Give xylocane injection as local anesthesia before puncture.

9. Pericardial fluid 6.Then insert the needle b/w intercostal space & allow the fluid to flow in container. 7. Pleural fluid is collected in 3 tubes: 1. EDTA Bulb: Cell count n differential count. 2. Fluorides Bulb: For glucose examination. 3. Plain Bulb: Chemical n immunology study

10. Pericardial fluid Examination of Pericardial fluid: Physical examination: Chemical examination: Microscopic examination:

11. Pericardial fluid Physical examination of Pericardial fluid: 1.Volume: Normally: 10 to 60 ml Transudates – 100 to 150 ml Condition: Increase hydrostatic pressure Decrease plasma oncotic pressure Congestive heart failure Hepatic cirrhosis Hypoproteinemia Exudates – More than 150 ml Condition: Pericardiatis ( Bacterial, Viral, Fungal) Tuberculosis Metastatic carcinoma, Lymphoma, Myocardial infract Rheumatoid disease Systemic lupus erythreomatous Uremia, Myxodema , Hypothyrodism HIV Infected patient

12. Pericardial fluid 2. color : Normally: colorless Transudates : Colorless Exudates: Reddish: Presence of blood (Bacterial pneumonia, Cancer, Pancreatitis .),Tuberculosis, SLE, Post MI syndrome Straw clr ; Pale yellow or straw clr Milky white:Presence of chlye

13. Pericardial fluid 3.Appreance: Normally: Clear or transparent Transudate : Clear or transparent Exudate : Turbid: Bacterial n viral Pericardiatis,TB , Malignancy Cloudy : Bacterial n fungal pericardiatis ,Post MI syndrome, septic condition ,Rheumatoid inflammation Milky : Chylous effusion

14. Pericardial fluid 4. Clot: Normally: absent Transudate : absent Exudate : Present Tuberculosis 5,Specific gravity: Transudate : below 1.010 Exudate : above 1.010 Pericardiatis ( Bacterial, Viral, Fungal ) TB Cancer SLE Rheumatoid Inflammation

15. Pericardial fluid Chemical examination of Pleural fluid : 1.Glucose: Normal range: same as blood glucose Transudate : same as blood glucose Exudate : slightly reduce Method: 1.Visualised method Benedict test 2.Colorimetric method GOD-POD Condition for decrease glucose: Bacterial ,fungal, viral( pericardiatis ) Tuberculosis Rheumatoid Inflammation, Cancer.

16. Pericardial fluid 2. Protein: Normal range: 6-8gm/dl Transudate : below 3 gm/dl Exudate : Above 3 gm/dl Method: 1.Turbidometric method method SSA Heat n acetic acid 2.Colorimetric method Biuret Condition for Increase protein: Pericardiatis (Bacterial , fungal,viral ) Tuberculosis

17. Pericardial fluid 3. Lipid : ( Tg ) Normal range: 50-110 mg/dl Transudate : Normal Exudate : Above 110U/L Method: 1.Colorimetric method Condition for Increase protein: Chylous effusion

18. Pericardial fluid 4. LDH: Normal range: 140 U/L Transudate : Normal Exudate : Above 140 U/L Method: 1.Colorimetric method 2. U.V.Kinetic method Condition for Increase protein: Pericardiatis Melingancy

19. Pericardial fluid 5.Creatinen kinase : Ck- mb level is increase in heart disease. Mainly in Myocardial injury. 6.ADA(Adenosine deaminase ): Increase in Tb pericardiatis .

20. Pericardial fluid 7.PH: Normally:7.64 Decrease ph in :7.20-7.30 Condition: Malignancy Uremia TB Idiopathic disorder 8.Interferon gamma: Increase level in Tuberculous pericardiatis .

21. Pericardial fluid Microscopic examination of pericadial fluid: 1.TLC (Total leukocyte count): Normally: 0-50 cell/ cumm Transudate : 0-50 cell/ cumm Exudate : 50-500 cell Method: Same as Blood Condition in increase TLC count: Bacterial Pericarditis Viral Pericardiatis Fungal Pericardiatis Tuberculosis Malignancy SLE Congestive heart failure Hypersensitivity reaction

22. Pericardial Fluid 2. DC: Method: Same as Blood Neutrophilia : Bacterial Pericardiatis Myocardial infraction Tuberculous Pericardatis Metastatic Tumor Lymphocytosis : Viral Pericardiatis Tuberculosis Malignancy Rheumatoid Inflammation SLE Leukemia Eosinophilia : Parasitic Infection Leukemia Hypersensitivity reaction Congestive heart failure

23. Pericardial Fluid 3.Gram’s Stain: Normally: Bacteria absent Transudate : Bacteria absent Exudates: Bacteria present Clinical Condition: Bacterial Pericardiatis Bacteria: Streptococcus S.pneumoniae S.aureus S.pyogenus Pseudomonas Gram negetiv e bacilli 4.AFB Stain: Normally: Bacteria absent Transudate : Bacteria present Exudates: Bacteria present Clinical Condition: Tuberculous Pericardiatis Bacteria: Mycobacterium Tuberculosis