Last updated: 02/17/2009

The typical symptom associated with patients requiring pericardiocentesis is chest pain, usually indicative of severe effusion. Patients with cardiac tamponade commonly have dyspnea (difficulty breathing) and those with an infection may have fever....

Some patients may have a hoarse voice from compression of a nerve called the recurrent laryngeal nerve; the pericardial sac may be so large that it pushes or compresses neighboring anatomical structures. Physical symptoms may vary, dependent both on size and the rate of filling of the pericardial effusion. Patients can also present with the following physical symptoms:

• tachycardia, an increased heart rate
• tachypnea, an increase in breathing rate
• jugular vein enlargement
• narrow pulse pressure (pulsus paradoxus)
• pericardial friction rub
• elevated central venous pressure
• hiccups from esophageal compression
• Ewart's sign (dull sound when the doctor taps the chest, tactile fremitus, egobronchophony)

The procedure can be performed in an emergency room, ICU, or at the bedside. Before the procedure patients should have an echocardiogram and basic blood analysis. No special dietary restrictions are required for pericardiocentesis. The patient will receive an IV line for sedation or other necessary medications and an electrocardiogram (ECG) to monitor cardiac activity. The patient must lie flat on the table, with the body elevated to a 60-degree angle. If the test is elective, then food and water restriction is recommended for six hours before the test. For infants and children, preparation depends on the child's age, level of trust, and previous exposure to this or similar procedures.