Pericardial Effusion

Pericardial effusion refers to the abnormal accumulation of fluid in the pericardial cavity, the space between the heart and the pericardium (the double-layered sac surrounding the heart). While small amounts of fluid are normal and act as a lubricant, excessive fluid buildup can lead to severe complications, including cardiac tamponade, a life-threatening condition.

In this comprehensive guide, we’ll explore everything you need to know about pericardial effusion—its causes, symptoms, diagnostic tests, treatment options, and when to seek medical attention.

Understanding the Pericardium

The pericardium is a thin, two-layered sac that surrounds the heart. It serves several vital functions:

• Protects the heart from infection and physical trauma

• Prevents over-expansion of the heart when blood volume increases

• Lubricates the heart to reduce friction during beats

Between the two layers of the pericardium lies a small amount of fluid (normally 15–50 mL) that helps reduce friction. When this space fills with more fluid than normal, it leads to pericardial effusion.

What Is Pericardial Effusion?

Pericardial effusion is the accumulation of excess fluid in the pericardial space. The fluid may be:

• Serous (clear fluid)

• Purulent (infected pus-like fluid)

• Hemorrhagic (blood)

• Chylous (lymphatic fluid)

The severity depends on:

• Volume of fluid

• Rate of accumulation

• Elasticity of the pericardium

A rapidly accumulating small effusion may cause more damage than a slowly developing large effusion.

Causes of Pericardial Effusion

Pericardial effusion may result from numerous underlying conditions, including:

1. Infections

• Viral pericarditis (e.g., Coxsackievirus, HIV)

• Tuberculosis (TB) – common in developing countries

• Bacterial infections

• Fungal infections

2. Inflammatory and Autoimmune Diseases

• Systemic lupus erythematosus (SLE)

• Rheumatoid arthritis

• Scleroderma

• Post-myocardial infarction (Dressler’s syndrome)

3. Cancer (Malignant Effusion)

• Lung cancer, breast cancer, lymphoma, or metastases can infiltrate the pericardium

4. Trauma or Surgery

• Blunt or penetrating chest trauma

• Post-cardiac surgery or pacemaker placement

5. Kidney Failure

• Uremic pericarditis in patients with end-stage renal disease

6. Hypothyroidism

• Can cause a slow accumulation of serous fluid

7. Medications

• Certain chemotherapy drugs

• Hydralazine or isoniazid

8. Radiation Therapy

• Especially when involving the chest

Signs and Symptoms of Pericardial Effusion

Many small or slowly developing pericardial effusions are asymptomatic. However, larger or rapidly accumulating effusions can produce the following symptoms:

• Chest pain (sharp or pressure-like)

• Shortness of breath (dyspnea), especially when lying down

• Palpitations

• Cough

• Fatigue or weakness

• Fever (if infection-related)

• Hoarseness or hiccups (due to compression of nearby structures)

Signs of Cardiac Tamponade (Medical Emergency):

• Hypotension (low blood pressure)

• Jugular venous distension

• Muffled heart sounds

• Tachycardia (rapid heart rate)

• Pulsus paradoxus (drop in BP during inspiration)

This triad—known as Beck’s Triad—is a hallmark of cardiac tamponade.

Diagnosis of Pericardial Effusion

1. Physical Examination

• Pericardial friction rub

• Decreased heart sounds

• Signs of right heart failure

2. Echocardiography (2D Echo)

This is the gold standard for diagnosing pericardial effusion. It can detect:

• Size and location of the fluid

• Evidence of tamponade

• Heart chamber compression

🩺 Get a 2D Echo with Colour Doppler at Sparsh Diagnostic Centre for accurate cardiac assessment.

3. Electrocardiogram (ECG)

• Low voltage QRS complexes

• Electrical alternans (alternating QRS amplitude)

4. Chest X-ray

• Enlarged cardiac silhouette if effusion is large

• Helps rule out lung conditions

5. CT or MRI of the Chest

• Offers more detailed imaging

• Useful if echocardiogram is inconclusive

6. Pericardiocentesis and Fluid Analysis

• Performed to drain fluid for diagnostic testing

• Helps identify infection, malignancy, or autoimmune causes

7. Blood Tests

• CBC, ESR, CRP, renal function, thyroid tests, ANA, TB markers, etc.

Types of Pericardial Effusion (Based on Duration)

• Acute Effusion: Develops over a few hours to days

• Subacute Effusion: Develops over days to weeks

• Chronic Effusion: Lasts for more than three months

Grading of Pericardial Effusion

• Mild: <10 mm

• Moderate: 10–20 mm

• Large: >20 mm

• Very Large: >25 mm or signs of tamponade

Echocardiography helps accurately measure the fluid and monitor progression.

Treatment of Pericardial Effusion

Treatment depends on the underlying cause, size of the effusion, and presence of symptoms or tamponade.

1. Observation and Medical Therapy

• Asymptomatic small effusions: may not require active treatment; regular monitoring with echo

• Anti-inflammatory drugs: NSAIDs (like ibuprofen) or colchicine

• Steroids: for autoimmune causes

• Antibiotics: for bacterial infections

• Antitubercular therapy: for TB-related effusion

• Dialysis: if due to uremia

2. Pericardiocentesis

• Needle inserted under ultrasound or echocardiographic guidance

• Immediate relief in tamponade

• Fluid sent for diagnostic analysis

3. Surgical Options

• Pericardial window (pericardiostomy): a small incision to allow continuous drainage

• Pericardiectomy: removal of pericardium, used in chronic or recurrent cases

4. Treating the Underlying Cause

• Cancer treatment for malignant effusion

• Hormone therapy for hypothyroidism

• Immunosuppressants for autoimmune disease

Complications of Untreated Pericardial Effusion

• Cardiac Tamponade (life-threatening pressure on the heart)

• Constrictive pericarditis

• Heart failure

• Shock and death

Prompt diagnosis and treatment are critical to prevent complications.

Prognosis

The prognosis of pericardial effusion depends on:

• Cause of effusion

• Speed of fluid accumulation

• Presence of tamponade

• Response to treatment

Infections and trauma-related effusions often have good outcomes with timely treatment. Malignant or recurrent effusions may require long-term monitoring and management.

Preventive Measures

While some causes are unavoidable, you can reduce your risk of developing pericardial effusion by:

• Managing chronic diseases like kidney failure and autoimmune disorders

• Completing prescribed antibiotics for infections

• Regularly monitoring heart conditions with echocardiograms

• Avoiding exposure to TB and other infections

• Discussing side effects of medications with your doctor

When to Seek Immediate Medical Help

You should seek emergency care if you experience:

• Sudden chest pain

• Rapid heartbeat

• Difficulty breathing

• Lightheadedness or fainting

• Low blood pressure

These may be signs of cardiac tamponade and require urgent treatment.

Pericardial Effusion in Children and Pregnancy

In Children

• Can occur due to viral infections, autoimmune diseases, or post-surgery

• Needs close monitoring and pediatric cardiologist evaluation

In Pregnancy

• Rare, but possible due to infections or autoimmune flare-ups

• Requires coordinated care between obstetrician and cardiologist

• Fetal echocardiography may be needed for congenital anomalies

📌 For prenatal cardiac screening, visit our Fetal Echocardiography service page.

Pericardial effusion is a potentially serious condition that requires prompt attention. While mild cases can be managed with medication and monitoring, larger or rapidly accumulating effusions may need invasive intervention. Regular cardiac evaluations with echocardiography can detect fluid buildup early and prevent complications like cardiac tamponade.

If you’re experiencing unexplained chest discomfort, fatigue, or breathlessness, don’t ignore the symptoms. Visit a trusted cardiac imaging centre like Sparsh Diagnostic Centre for expert evaluation.

📞 Call now to book your echocardiography: 98301 17733
🌐 Visit: https://www.sparshdiagnostica.com/echocardiography/