Pericardial Effusion


Pericardial effusion is an abnormal fluid build-up within the pericardium of the heart. The

pericardium normally has 15-50mL of fluid that acts as lubrication for the heart to contract

properly. Pericardial effusion can form from exudative fluid secondary to pericarditis,

trauma, heart surgery or malignancy. Transudative fluid can also build up within the pericardium if lymphatic channels become blocked. Normally, if the fluid build-up is slow, the heart has enough time to accommodate the recent change in pressure. However, if the fluid build-up is too quick, it can lead to cardiac tamponade. The increase pressure from the fluid around the heart, can prevent the myocardium from contracting uniformly leading to decreased cardiac output and perfusion.



Common signs and symptoms of pericardial effusion include chest pain, pressure or

discomfort, light-headedness, syncope, palpitations, and dyspnea. Physical exam

findings are pericardial friction rub, tachycardia, tachypnea, and decreased heart sounds.



Screening for pericardial effusion can be done with a chest x-ray which will show the

effusion and cardiomegaly if the condition is chronic. However, the most diagnostic test

is an echocardiogram that will show compressed chambers and fluid build up above the level of the descending aorta. Electrocardiogram changes can include electrical alternans and decreased QRS voltage.



Smaller effusions on patients that are asymptomatic and hemodynamically stable can be

observed using serial echocardiograms. Larger effusions or cardiac tamponade will need emergent pericardiocentesis. Patients with recurrent effusions can benefit from a creation of a pericardial window or a pericardiectomy. Treatment of secondary causes such as pericarditis, malignancy or trauma should also be implemented.

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