Pericardial Effusion

Also known as

Cardiac tamponade

The heart sits in an envelope of tissue called the pericardial sac. Under normal conditions, minimal fluid (just enough for “lubrication”) is present. If, however, the pericardial sac is allowed to fill with fluid, a condition known as Pericardial Effusion occurs.

This can reach dangerous levels in which the heart is no longer able to pump, resulting in Cardiac Tamponade — a life-threatening condition that may lead to Cardiac Arrest.

Chest pain that is usually worse with a deep breath; pain improves by leaning forward.
Shortness of breath
Cough may be present

Fainting, lightheadedness, unconsciousness, or Cardiac Arrest may be present in the case of Cardiac Tamponade

Dressler’s syndrome (Pericarditis that occurs after a heart attack or after heart bypass surgery)
Renal failure
Uremic Pericarditis
Trauma/Injury
Neoplastic (cancer) Pericarditis
Infectious Pericarditis
Rheumatic Fever
Viral Pericarditis
Tuberculous Pericarditis
Radiation induced Pericarditis
Systemic Lupus Erythematosus
Hypothyroidism
Rheumatoid Arthritis
In all these cases, there is Pericarditis (i.e. inflammation of the pericardial tissue). This inflammation results in fluid release and build up in the pericardial sac. Pericarditis only rarely leads to actual Cardiac Tamponade.

1. Tachycardia (heart rate is elevated usually above 100)
2. Heart exam may reveal a pericardial rub
3. Tachypnea (rapid breathing)
4. Pulsus paradoxus (systolic blood pressure drops by more than 10 mm Hg during inspiration)
5. Ascites (swelling of the abdomen) and edema (leg swelling) may be present

Central venous pressure (may be checked with a special catheter) is usually elevated
Laboratory tests, e.g., sedimentation rate, ANA, Rheumatoid factor.
Chemistry panel to check kidney function and assess for uremic Pericarditis (as well as other abnormalities). Complete blood count and thyroid function tests should be evaluated.
Consider TB skin testing
Chest X-Ray shows an enlarged cardiac silhouette
EKG usually shows low voltage. Electrical alternans, if present, confirms the diagnosis (but is often not). Also check for signs of Pericarditis — diffuse ST elevation or diffuse T wave inversions (be cautious, as may mimic a heart attack or a juvenile pattern)
Echocardiogram confirms the diagnosis
Pericardiocentesis (removal of fluid from the pericardial sac) can be used to treat the Pericardial Effusion/tamponade and the fluid can be sent to the lab and help make the diagnosis.

Pericardial biopsy may be necessary to determine the cause of the Pericardial Effusion

Treat the underlying cause (e.g., kidney failure is treated with dialysis, Dressler’s syndrome is often treated with nonsteroidal anti-inflammatory medications)

When Pericardial Tamponade occurs, urgent Pericardiocentesis is needed (removal of fluid from the pericardial sac, usually done by guiding a needle with either an EKG or an Echocardiogram)

Pericardial Effusions usually represent a serious medical condition, and medical treatment should be sought immediately. Cardiac Tamponade is a life-threatening emergency, requiring immediate medical treatment.