What is pericardial effusion?
Pericardial effusion is a buildup of fluid around the heart muscle. The heart is surrounded by a protective membrane called the pericardium, which is a sac comprised of two layers of tissue with lubricating fluid in between. Pericardial effusion occurs when the amount of fluid between the two pericardium (sac) layers is abnormally high.
Good to know: Effusion is the medical term for a buildup of fluid. Effusions can occur in other parts of the body besides the heart membrane. For example, fluid can build up around the lungs; this is called pleural effusion.
Often, pericardial effusion is mild, progresses slowly, does not cause any signs or symptoms, and is discovered incidentally as part of a routine medical check-up. However, if the pericardial effusion develops or progresses rapidly, the pressure it exerts may compromise the functioning of the heart and lead to serious complications, particularly where there is a large amount of fluid.
Signs of pericardial effusion may include:
- Chest pain
- Rapid heartbeat
- Feeling lightheaded
Pericardial effusion can be caused by almost any disease or health condition that affects the pericardium, including:
- Pericarditis (inflammation of the pericardium)
- Infections and systemic disorders, for example, hypothyroidism, systemic lupus erythematosus and rheumatoid arthritis
- Kidney failure and cancer.
While pericardial effusion can affect people of all ages, the incidence seems to be higher in those over 50. Generally speaking, in younger people the heart is better able to compensate for a progressing effusion.
The prognosis for pericardial effusion depends on the size of the effusion and the underlying cause. Small effusions are quite common and may simply require monitoring by a doctor, often resolving on their own with supportive treatment.
Where necessary, treatment for pericardial effusion involves addressing the cause, for example by prescribing antibiotics for a bacterial infection, steroids and other medications for rheumatoid arthritis, or anti-inflammatory medications for pericarditis. Large effusions typically indicate a more serious health condition and may require drainage (pericardiocentesis). Recovery may take several weeks or months, depending on the severity and cause of the pericardial effusion.
A possible complication of pericardial effusion is cardiac tamponade, which is a medical emergency requiring immediate intervention.
Signs and symptoms of pericardial effusion
Signs and symptoms depend on the size of the heart effusion and the rate at which it develops. People with small pericardial effusions that have developed slowly may not experience any specific symptoms at all. However, there may be symptoms related to the underlying cause, for example, fever from pericarditis.
Where present, symptoms of pericardial effusion may include:
- Feeling light-headed or fainting
- Rapid heartbeat (tachycardia)
- Shortness of breath or difficulty breathing
- Chest pain, pressure or discomfort. This symptom may be worse when lying flat on the back, and relieved by sitting up and leaning forward
- Difficulty swallowing
- Anxiety and confusion
- Nausea and vomiting
- Feeling of fullness in the abdomen
- Abdominal distension (bloating)
Worried you may have pericardial effusion? Check your symptoms with Ada.
A wide range of health conditions can cause pericardial effusion. Possible causes include the following:
- Pericarditis (acute or chronic)
- Viral infection (e.g., HIV)
- Bacterial, fungal or parasitic infection, including tuberculosis
- Heart attack
- Heart surgery
- Chest trauma
- Kidney failure or injury
- Severe untreated hypothyroidism
- Whipple’s disease
- Familial Mediterranean fever
- Radiation (e.g., radiotherapy)
- Sarcoidosis (an inflammatory condition that can affect many organs)
- Autoimmune conditions (e.g., systemic lupus erythematosus and rheumatoid arthritis
- Certain medications (e.g., blood pressure and blood clotting medications)
In many cases of pericardial effusion the cause of the fluid buildup is unknown. This is called idiopathic pericardial effusion.
Diagnosing pericardial effusion
The first step in diagnosing pericardial effusion will be for a doctor to take the affected person’s medical history and perform a physical examination. The doctor will typically measure the individual’s blood pressure, and pulse, and listen to the heart through a stethoscope for audible signs of fluid buildup.
Where the pericardial effusion has developed slowly, symptoms may be absent or minimal. A doctor will usually look for the following:
- Accelerated pulse
- Low blood pressure
- Muted heartbeat (through the stethoscope)
The doctor will also look for possible signs of chronic heart failure, including:
- General physical weakness
- Distended jugular veins (in the neck)
- Fast or labored (difficult) breathing
- Buildup of fluid in the abdomen (belly)
- Swollen legs
Rapid development of low blood pressure, muted heart sounds and distended jugular veins may indicate the life-threatening condition of cardiac tamponade.
It is likely that the doctor will request further tests, such as an ECG (electrocardiogram) or ultrasound, to confirm the diagnosis of pericardial effusion and establish the cause. Tests may include:
- Blood tests: These can identify infections, autoimmune conditions, thyroid dysfunction, kidney failure and other possible underlying causes of pericardial effusion.
- Echocardiogram: A heart ultrasound scan or echo will show the size and shape of the heart and whether fluid has accumulated in the pericardium. This type of scan, which is widely available, is particularly important in the diagnosis of pericardial effusion.
- Electrocardiography (ECG or EKG): An ECG is a test that measures the heart’s electrical activity. Pericardial effusion may cause abnormal patterns to show on an ECG.
- Chest X-ray: The heart may appear enlarged where there is significant pericardial effusion. It may have a “water bottle” shape.
- CT or MRI scan: Computed tomography (CT) and magnetic resonance imaging (MRI) tests may present a clearer picture of the presence and size of pericardial effusion.
- Pericardiocentesis: Removal of a small amount of fluid from the pericardium, using a needle, allows for testing for infections (e.g, tuberculosis) and tumor markers.
In addition, the doctor may ask for a pericardial biopsy to be performed. In this procedure, a small amount of tissue is removed from the pericardium to test for infection and other possible causes of pericardial effusion.
How is pericardial effusion treated?
Treatment of pericardial effusion depends on the cause and severity of the condition. In some cases where the effusion is small and uncomplicated, it may resolve on its own, with anti-inflammatory medication recommended to help the healing process.
Treatment approaches may include:
Strategies to reduce symptoms: These include:
- Oxygen therapy where circulation is compromised
- Diuretics (water pills)
- Other heart failure medication
Strategies to treat complications: These include pericardiocentesis where cardiac tamponade is present
Strategies to identify and treat the underlying condition: These include:
- Pericardiocentesis, pericardial biopsy, antibiotics where a bacterial infection is present
- Steroids and other medications where rheumatoid arthritis is implicated
- Chemotherapy, radiation therapy and other treatments where cancer is the cause
In some cases, surgical treatment may be necessary.
Treating pericarditis (inflammation of the pericardium)
If pericarditis is present, treatment may include NSAIDs and, in certain cases, a course of colchicine – another type of medication that reduces inflammation. Colchicine may improve the prognosis and help prevent pericarditis recurring. If the pericarditis does not respond to treatment, a course of corticosteroids, such as prednisone, may be necessary. In cases of acute pericarditis caused by myocardial infarction (heart attack), however, corticosteroids cannot be used, as they may negatively affect the healing process.
Read more about pericarditis treatment »
Large effusions that persist or are at risk of causing cardiac tamponade may be treated with pericardiocentesis. In this procedure, excess fluid is drained from the pericardium using a needle and catheter (thin tube). The doctor will typically rely on echocardiography (ultrasound) to guide the process.
Where the pericardial effusion is very large and repeated pericardiocentesis has not been effective, surgery may be recommended. The following procedures may be used:
Subxiphoid pericardiostomy: Also called a “pericardial window”, this procedure can be performed under local anesthesia and has a high success rate. The doctor will make an incision under the breastbone and remove a small part of the pericardium to drain the excess fluid.
Video-assisted thoracoscopic surgery: This is also known as VATS or thoracoscopy. Although the procedure involves general anesthesia, it is minimally invasive, requiring only small incisions in the chest wall. The doctor will use a tiny camera to view the pericardium and make a more accurate diagnosis, and can then drain excess fluid by creating a small hole in the pericardium (pleuropericardial window).
Alternatives to surgery
Where surgery is not recommended, the following interventions may be used:
Percutaneous balloon pericardiotomy: During this procedure, a doctor inserts a needle into the pericardium via the chest wall. The needle is then replaced with a catheter, which has an inflatable balloon at the tip. This balloon is inflated to create a small hole in the pericardium through which excess fluid can be drained. Balloon pericardiotomy is predominantly used for repeated pericardial effusion that is caused by cancer.
Intrapericardial sclerosis: In this procedure, a medication is administered to the pericardium to treat the effusion. Medications used include the antibiotics tetracycline and doxycycline and the chemotherapy drug cisplatin, among others.
Complications that can arise from pericardial effusion include cardiac tamponade, as well as large effusions that recur or persist for longer than six months.
This is a life-threatening condition that may develop from pericardial effusion. If the fluid exerts pressure on the heart to the extent that its pumping ability is compromised, immediate treatment is required to prevent mortality.
Symptoms of cardiac tamponade may develop rapidly (within minutes or hours) and can include:
- Shortness of breath
- Weakness and faintness
- Confusion or loss of consciousness
- Blurred vision
If you think that you might have signs of cardiac tamponade, call emergency services immediately.
Cardiac tamponade is treated with emergency pericardiocentesis or surgery. In severe cases, cardiopulmonary resuscitation (CPR) may be required.
Chronic pericardial effusion
In some cases, large effusions may recur or persist for longer than six months and require ongoing medical treatment. The affected individual may not experience any symptoms or problems. However, because pericardial effusion may lead to cardiac tamponade, going for regular check-ups and ensuring careful management of heart health is critical. The doctor may recommend pericardiocentesis to drain the cardiac effusion as a preventative measure. In many cases, however, pericardiocentesis alone may prove inadequate, and a pericardiectomy may also be necessary.
Good to know: Small pericardial effusions that persist for a long period of time are fairly common, and are not as much of a concern as large effusions.
Q: What causes fluid around the heart?
A: Pericardial effusion can be caused by many different conditions that affect the membrane of the heart, resulting in pericarditis. These include:
- Viral and bacterial infections such as tuberculosis
- Kidney failure
- Systemic lupus erythematosus
- Rheumatoid arthritis
- Inadequately managed hypothyroidism
- Chest injuries
- Heart attack
- Heart surgery
- Some medications
In many cases, the cause of pericardial effusion is unknown.
Q: Is pericardial effusion serious?
A: Pericardial effusion can be serious. Many cases are mild and do not cause any symptoms or long-term health problems, but some cases,particularly those that develop rapidly and involve a large buildup of fluid, can lead to life-threatening complications such as cardiac tamponade. If you think that you might have signs of pericardial effusion, it is recommended that you contact a doctor without delay.
Q: Can pericardial effusion return?
A: Yes, pericardial effusion can recur. Many cases clear up and do not come back, but in some cases chronic pericardial effusion may develop. See the section on chronic pericardial effusion above for more details.
Q: Pericardial effusion vs. cardiac tamponade – what is the difference?
A: Pericardial effusion is the term for an accumulation of fluid around the heart. The amount of fluid may be small or large, and the condition is not always serious or life-threatening. Cardiac tamponade is a rare but life-threatening possible complication of pericardial effusion and other heart conditions. Cardiac tamponade is when fluid exerts pressure on the heart, impeding its ability to pump and sometimes leading to cardiac arrest. Cardiac tamponade may develop very quickly and requires emergency treatment to prevent mortality.
Q: Pericardial effusion vs. pericarditis - what is the difference?
A: Pericardial effusion is the term for a buildup of fluid around the heart. The membrane around the heart is called the pericardium; this is a sac made up of two layers of tissue with lubricating fluid in the middle. If this fluid increases beyond normal levels, it is called pericardial effusion. Pericarditis is the term for inflammation of the pericardium. Pericarditis can cause pericardial effusion.
Read more about Pericarditis »
Q: Pericardial effusion vs. pleural effusion - what is the difference?
A: Pericardial effusion is the term for a buildup of fluid around the heart. Pleural effusion is the term for a buildup of fluid around the lungs, or, more accurately, in the space between the lungs and the chest cavity.
Q: Is there a connection between pericardial effusion and cancer?
A: Yes. Cancer may be a cause of pericardial effusion where it has spread to the pericardium. These cases of pericardial effusion are very serious and require urgent medical treatment. The types of cancer that most commonly cause pericardial effusion include:
- Lung cancer
- Breast cancer
Q: Can pericardial effusion be prevented?
A: It is not usually possible to prevent pericardial effusion. However, steps can be taken to prevent the condition becoming more serious or developing into cardiac tamponade. These steps include:
- Seeking treatment without delay
- Following the treatment plan (for example, taking medications as prescribed)
- Listening to a doctor’s advice for ongoing medical care
Other names for pericardial effusion
- Fluid around the heart
Acute accumulation may cause impaired cardiac filling and decreased cardiac output with as little as 100 mL of fluid, while chronic and slow accumulation may lead to significant effusions of one to two liters that produce no significant hemodynamic effects.Is a small amount of pericardial effusion normal? ›
Normally, there is a small amount of fluid between them. The fluid reduces friction between the two layers as they rub against each other during each heartbeat. In some cases, extra fluid can build up between these two layers leading to a pericardial effusion. A little fluid won't cause much of a problem.Should I be worried about pericardial effusion? ›
Pericardial effusion can put pressure on the heart, affecting how the heart works. If untreated, it may lead to heart failure or death in extreme cases.How much fluid typically needs to fill the pericardial sac before significant signs and symptoms of a pericardial tamponade develop? ›
Rapid accumulation of fluid (as with pericardial hemorrhage resulting from trauma) can lead to tamponade with even a very small volume of pericardial fluid (50 to 100 mL), whereas a slowly accumulating effusion (as with renal failure) can be large (>1000 mL) with minimal increase in pericardial pressures.How serious is a small pericardial effusion? ›
Most times, it's small and causes no serious problems. If it's large, it can compress your heart and hamper its ability to pump blood. This condition, called cardiac tamponade, is potentially life-threatening. To find the cause of a pericardial effusion, your doctor may take a sample of the pericardial fluid.How is a small pericardial effusion treated? ›
Drainage procedures or surgery to treat pericardial effusion may include: Fluid drainage (pericardiocentesis). A health care provider uses a needle to enter the pericardial space and then inserts a small tube (catheter) to drain the fluid. Imaging techniques, typically echocardiography, are used to guide the work.What is minimal pericardial effusion? ›
Pericardial effusion is a buildup of fluid in the space around the heart. It can happen for a wide range of reasons, including infections, injuries or other medical conditions. If the buildup is severe or happens quickly, it can compress your heart and cause cardiac tamponade, a life-threatening medical emergency.Can fluid around the heart go away on its own? ›
If there is only a small amount of extra fluid in your pericardium, you may not need treatment. The extra fluid may go away on its own. Treatment depends on the cause of the extra fluid, the amount of fluid, and your symptoms.How fast can pericardial effusion develop? ›
Pericardial effusion is the medical term for fluid buildup in the space around the heart. More specifically, the fluid appears between the membrane sac lining that surrounds the heart, the pericardium, and the heart itself. This condition can come on quickly, sometimes in less than a week.Can a small pericardial effusion get worse? ›
However, if the pericardial effusion develops or progresses rapidly, the pressure it exerts may compromise the functioning of the heart and lead to serious complications, particularly where there is a large amount of fluid. Signs of pericardial effusion may include: Chest pain. Rapid heartbeat.
Current guidelines recommend that return to physical exercise or sport is permissible if there is no longer evidence of active disease. This includes the absence of fever, absence of pericardial effusion, and normalization of inflammatory markers (ESR and or C-reactive protein).How long is recovery from pericardial effusion? ›
It is common to feel tired for several days or weeks after surgery. Your doctor will give you medicine to help with pain. The amount of time you will need to recover at home depends on your health and the type of surgery you had. If you work, you will probably need to take at least 1 week off.What is the normal amount of fluid around the heart? ›
The pericardium is a tough and layered sac. When your heart beats, it slides easily within it. Normally, 2 to 3 tablespoons of clear, yellow pericardial fluid are between the sac's two layers.What viruses cause pericardial effusion? ›
Acute pericarditis (AP), or pericardial sac inflammation, is a self-limited condition in healthy individuals. Viruses, including adenoviruses, enteroviruses, cytomegalovirus, and influenza virus, have been well documented to cause AP.What is physiologic amount of pericardial fluid? ›
Under normal conditions, the human pericardial cavity contains 20–60 ml of fluid (Chinchoy, 2005).Can pericardial effusion be cured? ›
Depending on the severity of the buildup, pericardial effusion may be treatable with medicines. If the health care team determines that it's necessary to drain the excess fluid, they may recommend a procedure called pericardiocentesis, which uses a needle and small catheter to drain the fluid.What medications cause pericardial effusion? ›
Causes of Pericardial Effusion
Certain prescription drugs, such as hydralazine, a medication for high blood pressure; isoniazid, a tuberculosis drug; and phenytoin, a medication for epileptic seizures. Chemotherapy drugs, such as doxorubicin and cyclophosphamide. Blockage of the flow of pericardial fluids.
Stress cardiomyopathy (CMP) has been described as a complication of post-myocardial infarction pericarditis (Dressler syndrome). Stress CMP can also be complicated by pericarditis. We describe the novel observation where idiopathic pericarditis is the primary disease, which precipitated stress CMP.What are the types of pericardial effusion? ›
transudative effusion: due to non-inflammatory causes (congestive heart failure , myxoedema , nephrotic syndrome ) exudative effusion: inflammatory or malignant causes (tuberculosis , spread from empyema , metastasis) hemorrhagic effusion: high blood concentration (trauma, rupture of aneurysms, malignant effusion)Can I exercise if I have pericarditis? ›
Don't do any strenuous activity for a few weeks, until your pericarditis has gone and your heart is back to normal. This will help to reduce your risk of low blood pressure and abnormal heart rhythms. If you're normally very active and do a lot of sport, you may need to limit exercise for at least three months.
The chest X-ray on the left is normal. The image on the right shows a mass in the right lung. Chest X-rays produce images of your heart, lungs, blood vessels, airways, and the bones of your chest and spine. Chest X-rays can also reveal fluid in or around your lungs or air surrounding a lung.Can fluid around the heart cause coughing? ›
A weak heart causes fluid to back up in the lungs. This can cause shortness of breath with exercise or difficulty breathing at rest or when lying flat in bed. Lung congestion can also cause a dry, hacking cough or wheezing. Fluid and water retention.Can fluid around the heart be treated with medication? ›
Diuretics help your body get rid of extra fluid. They are often called "water pills." There are many brands of diuretics.Is pericardial effusion heart failure? ›
Abstract. Transudative pleural and pericardial effusions are not uncommon in patients with congestive heart failure. Pericardial effusion forms only with elevation of the right-sided filling pressure in the heart.What does a pericardial effusion feel like? ›
Pericardial effusion is an alarming thing to experience: A common symptom of this condition is a sharp, stabbing chest pain that comes on quickly. Other common symptoms include shortness of breath and low blood pressure.Does pericardial effusion cause fatigue? ›
Symptoms of a significant effusion may include:
Fatigue. Shortness of breath. Passing out or fainting. Palpitations.
Pericarditis and myocarditis usually require temporary restriction and return to flying duties is usually dependent on a lack of recurrent symptoms and acceptable imaging and electrophysiological investigations.What should I avoid if I have pericarditis? ›
For mild pericarditis, rest and over-the-counter pain medications — taken as directed by your care provider — may be all that's needed. While you recover, avoid strenuous physical activity and competitive sports. Such activity can trigger pericarditis symptoms. Ask your health care provider how long you need to rest.Does pericardial effusion cause shortness of breath? ›
Pericardial effusion may not cause any noticeable signs and symptoms, particularly if the fluid has increased slowly. If pericardial effusion signs and symptoms do occur, they might include: Shortness of breath or difficulty breathing (dyspnea)How long does pericardial effusion pain last? ›
Pericarditis usually develops suddenly and may last from weeks up to several months. The condition usually clears up after three months, but sometimes attacks can come and go for years. Sometimes there is extra fluid in the space between the pericardial layers, which is called pericardial effusion.
Just as other symptoms of hypothyroidism, pericardial effusions can be reversed over time with thyroid hormone replacement .What does inflammation of the heart feel like? ›
Myocarditis is inflammation of the heart muscle (myocardium). The inflammation can reduce the heart's ability to pump blood. Myocarditis can cause chest pain, shortness of breath, and rapid or irregular heart rhythms (arrhythmias). Infection with a virus is one cause of myocarditis.Can a bacterial infection cause pericardial effusion? ›
Bacterial infections are one cause of pericarditis. The bacterial infection causes the pericardium to become swollen and inflamed. Pain occurs as a result of the inflamed pericardium rubbing against the heart. Fluid may build up in the pericardial sac.What size is a trivial pericardial effusion? ›
Summary. Pericardial effusion is present when the fluid in the pericardial space exceeds its physiologic amount (≤50 mL).What causes small pericardial effusion? ›
The conditions that give rise to pericardial effusion are numerous and varied: Viral, bacterial, or fungal infections of the pericardium. Traumatic injury to the chest. Autoimmune disorders, such as lupus or rheumatoid arthritis.Where is pericardial effusion measured? ›
The easiest way to remember is that we always want to measure the effusion at the point in the cardiac cycle when the effusion is at its smallest. For this ventricular effusion, it should be measured at end-diastole, when it is at its smallest at the fluid-tissue interface (ie inner edge to inner edge technique).What is minimal pericardial effusion? ›
Pericardial effusion is a buildup of fluid in the space around the heart. It can happen for a wide range of reasons, including infections, injuries or other medical conditions. If the buildup is severe or happens quickly, it can compress your heart and cause cardiac tamponade, a life-threatening medical emergency.What is the normal amount of fluid around the heart? ›
The pericardium is a tough and layered sac. When your heart beats, it slides easily within it. Normally, 2 to 3 tablespoons of clear, yellow pericardial fluid are between the sac's two layers.What is the normal amount of pleural fluid? ›
In a healthy human, the pleural space contains a small amount of fluid (about 10 to 20 mL), with a low protein concentration (less than 1.5 g/dL).Can fluid around the heart go away on its own? ›
If there is only a small amount of extra fluid in your pericardium, you may not need treatment. The extra fluid may go away on its own. Treatment depends on the cause of the extra fluid, the amount of fluid, and your symptoms.
However, if the pericardial effusion develops or progresses rapidly, the pressure it exerts may compromise the functioning of the heart and lead to serious complications, particularly where there is a large amount of fluid. Signs of pericardial effusion may include: Chest pain. Rapid heartbeat.How long does it take to recover from fluid around the heart? ›
More specifically, the fluid appears between the membrane sac lining that surrounds the heart, the pericardium, and the heart itself. This condition can come on quickly, sometimes in less than a week. In chronic cases, it can last for more than 3 months.What virus causes pericardial effusion? ›
Epstein-Barr virus (EBV) is a rare cause of pericardial disease and can cause pericardial effusion and tamponade. Typical symptoms are non-specific, and include chest pain and shortness of breath.What is small to moderate pericardial effusion? ›
There is normally a small amount of fluid around the heart (small pericardial effusion). This is produced by the sac around the heart and is an important part of normal heart functioning. Excess fluid around the heart is known as a pericardial effusion.Can fluid around the heart be treated with medication? ›
Many medical conditions can cause fluid to build up around the heart. This fluid buildup can cause shortness of breath and chest pain. This may be treatable with medicine. In other cases, this fluid buildup is life threatening and needs draining right away.How do you feel when you have fluid around your heart? ›
Fluid around the heart symptoms
a feeling of “fullness” in your chest. discomfort when you lie down. shortness of breath (dyspnea) difficulty breathing.
Moderate effusions, measuring 20% to 40% of the hemithorax, corresponded to a mean of 690 mL (data not presented). These effusions are generally large enough that thoracentesis can be confidently performed. It is expected that imaging guidance may still be useful for sampling some effusions of this size.How much fluid is considered a large pleural effusion? ›
This space is usually filled with a very small amount of fluid. However, large amounts (4–5 litres in an adult) of fluid can accumulate in the pleural space under pathological conditions.What are the 2 types of pleural effusion? ›
- Transudative pleural effusion is caused by fluid leaking into the pleural space. ...
- Exudative effusion is caused by blocked blood vessels or lymph vessels, inflammation, infection, lung injury, and tumors.
Current guidelines recommend that return to physical exercise or sport is permissible if there is no longer evidence of active disease. This includes the absence of fever, absence of pericardial effusion, and normalization of inflammatory markers (ESR and or C-reactive protein).
Depending on the severity of the buildup, pericardial effusion may be treatable with medicines. If the health care team determines that it's necessary to drain the excess fluid, they may recommend a procedure called pericardiocentesis, which uses a needle and small catheter to drain the fluid.Can stress and anxiety cause pericarditis? ›
Stress cardiomyopathy (CMP) has been described as a complication of post-myocardial infarction pericarditis (Dressler syndrome). Stress CMP can also be complicated by pericarditis. We describe the novel observation where idiopathic pericarditis is the primary disease, which precipitated stress CMP.