Next time you are in the ICU have someone show you the sub-xyphoid view with the bedside ultrasound which can be a great way for assessing for an effusion. A nice demonstration of the view from YouTube is here and includes both normal and abnormal including what it looks like when there is an effusion!!!
Remember to keep in mind the complications of endomyocardial biopsy which include:
– myocardial perforation with pericardial tamponade
– heart block
– arterial puncture
– pulmonary embolization
– nerve block or injury
– damage to the tricuspid valve
– creation of arteriovenous fistula
– deep venous thrombosis
Also, don’t forget that most patients with cardiac tamponade will have elevated jugular venous pressure but if you don’t look for it you won’t see it!!