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

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

3.  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.  Composition of Pericardial fluid:
o Volume: 60-70 ml
o Cell/mm3: 1000-3000
Monocyte:30 %
Lymphocyte: 5%
Neutrophil: 5%
o Protein: up to 3 gm/dl
o Glucose: Same as plasma
o LDH:70-140 U/L

5.  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.  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.  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. 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. 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.  Examination of Pericardial fluid:
1. Physical examination:
2. Chemical examination:
3. Microscopic examination:

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

20. 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.  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. 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. 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