Pericardial Effusion

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

Pericardial effusion is the medical term used to define the accumulation of fluid in the pericardial cavity. This is the area or space surrounding the heart (see figure 1). This event could lead to an increase in heart’s pressure, which could cause chest pain, shortness of breath, and low blood pressure.

• Infections: Viral or bacterial infections can cause swelling of the pericardium, which causes fluid build up. Coxsackie B and adenovirus infections are the most typical causes.

• Inflammatory causes: Rheumatoid arthritis, lupus, and other autoimmune conditions can cause the pericardium to become inflamed, which can result in pericardial effusion.

• Cancer: Pericardial effusion can result from lung, breast, and stomach tumours that have spread to the pericardium.

• Trauma: A chest trauma may cause bleeding into the pericardial cavity, which could result in pericardial effusion.

• Idiopathic: no known cause.

A typical fluid that can build up in the pericardial space is blood. As a result, there is a decrease in cardiac output and interference with the heart's capacity to fill its chambers. Extreme cases of fluid accumulation can result in a cardiac tamponade, a potentially fatal condition in which the heart's pressure rises to a point where it cannot adequately supply the body with blood, leading to organ failure and, if left untreated, it can lead to death.

• Pericarditis: Individuals with a history of previous pericarditis (inflammation of the pericardium)

• Cancer

• Heart failure

• Autoimmune diseases:  Rheumatoid arthritis (RA) and lupus

• Medications: for example hydralazine and procainamide,

• Radiation therapy: radiation therapy performed around the chest area are at risk for pericardial effusion

• Idiopathic

• Trauma

Chest pain

• Shortness of breath (SOB) caused by buildup of fluid in the pericardial cavity. 

• Hypotension: caused by reduced cardiac out due to increased pressure on the heart.

• Tachycardia

• Fatigue

• Peripheral edema.

• Cough 

• In severe cases, cardiac tamponade

• Blood tests: FBC, CRP, ESR to check for the presence of raised inflammatory markers which could be linked to pericardial effusion. 

• Echocardiography

• Computed Tomography (CT) scan

• Magnetic Resonance Imaging (MRI)

• Pericardiocentesis: a needle is inserted into the pericardial cavity to drain the fluid. 

• Biopsy

• Cardiac catheterization: normally used to check the pressure in the pericardial cavity.

• Pericardiocentesis

• Treat underlying cause: infection? Inflammation? Autoimmune? 

• Surgery: repair/removal of pericardium or removal of tumour (if cancer present)