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A Pericardial Drain is usually an Emergency Procedure. Symptoms: The symptoms of cardiac tamponade (fluid in the sac around the heart compressing it) can be shock, and heart failure. Chest pain, bthealnessness, dizziness, low blood pressure and blackouts can all occur. Causes: It is caused by fluid accumulating in the pericardial sac. Normally there is a small amount of fluid in the sac for lubrication. Haemorrhage, such as from a penetrating wound to the heart or ventricular wall rupture after a heart attack (MI), can lead to a rapid increase in pericardial volume. Other risk factors, which tend to produce a slower-growing effusion, include infections (tuberculosis [TB], myocarditis), autoimmune diseases, cancers, kidney failure, and other inflammatory diseases (pericarditis). Diagnosis: The ECG can show small QRS complexes The Chest X ray can show an enlarged heart The CT can show the effusion The definitive test is an echocardiogram. It will show the fluid, and also if there are signs of tamponade. Treatment: No all fluid needs to be drained. It may get better given time. If there is tamponade, there may not be time! In that case a pericardial drain is needed. In some cases a drain is not feasible, and a surgical procedure is needed. A pericardial drain is an invasive procedure. Training is simulators can help, I have have trained many juniors to do it. Chet, my trainee in this video, has done the simulator, and I talked him through doing the procedure. Follow the steps in this video to learn how to do this procedure. Our young patient has done well after the drain.