Evaluation

Considerations

ECG

Distinguish ECG from early repolarization - typically seen in 30 % of young adults

Chest radiograph

Typically, normal - approximately 200 mL of fluid before notable cardiac silhouette enlargement

Complete blood count, chemistry profile, troponin level, erythrocyte sedimentation rate, and serum C-reactive protein level

Inflammatory disease can demonstrate serum elevations are neither sensitive nor specific and may not be helpful acutely; may only see elevation on follow up

HIV/serum viral studies

Yield dependent on risk factors (frequently low); viral studies not routine (unless predictive presenting history) - management unchanged for most viral etiologies

TTE

Small effusion can confirm pericarditis; Formal TTE post-operatively recommended for evaluation of anatomic structure and function

Additional testing to be considered based on detailed history

- Blood cultures if fever > 38 degrees

- Antinuclear antibody titer (esp. in young women with suggestive history)

- Computed tomography to differentiate pulmonary disease/malignancy

- Tuberculin skin test or interferon-gamma release assay

- Thyroid stimulating hormone (based on history)

Pericardial fluid analysis

Cultures are strongly recommended for effusions that appear purulent

       - Gram stain with aerobic and anaerobic cultures

       - Fungal stain and culture

       - Acid fast stain and mycobacterial culture

- Cytology

- Polymerase chain reaction) for viruses may be considered (low yield, specific studies dependent on risk factors and presentation)