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Pericardial Effusion - Causes, Symptoms, Diagnosis, Prevention, and Treatment

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Pericardial effusion refers to the accumulation of excess fluid in the pericardium of the heart. This article is a brief overview of pericardial effusion.

Written byDr. Shaqra Ekram

Medically reviewed byDr. Sapkal Ganeshrao Patilba

Published At December 19, 2022
Reviewed AtSeptember 17, 2024

What Is Pericardial Effusion?

Pericardial effusion is the accumulation of excess fluid in the heart and the protective sac surrounding it, the pericardium. In most cases, this accumulation resolves on its own over time but may eventually lead to the heart not functioning smoothly. The pericardium is a dual-layered protective sac encompassing the heart that is fibro-elastic.

It is a physical barrier that clutches the heart in place and assists in its regular functioning by lubrication. Diseases to the pericardium come into the picture if there is swelling or when fluid starts filling the pericardium. Such swellings and fluid accumulation in the pericardium are dangerous and lead to heart dysfunction. The pericardial cavity is a small area between the pericardium and the heart. When this pericardium gets filled with blood or fluid, it results in pericardial effusion.

How Prevalent Is Pericardial Effusion?

The prevalence of this condition is relatively high. Individuals of any age group can experience this condition due to various causes.

What Happens During Pericardial Effusion?

The pericardium is a double-layered protective covering of the heart. When the heart beats, the heart slides smoothly against the pericardium. Anatomically, approximately two to three tablespoons of yellow, clear pericardial fluid linger between the protective sac of the heart. This particular fluid aids in a non-friction movement of the heart. In the case of pericardial effusion, there is an excess of pericardial fluid within the heart’s cavity. Minor cases of pericardial effusion may result in approximately a hundred milliliters of fluid while a major case may lead to an accumulation of approximately two liters of pericardial fluid.

What Are the Signs and Symptoms of Pericardial Effusion?

Chest pain is one of the most common clinical manifestations of pericardial effusion. Leaning forward and breathing may increase the discomfort caused by pericardial effusion.

Mentioned below are the signs and symptoms of pericardial effusion :

  • Fever.

  • Fatigue.

  • Pain in the muscles.

  • Shortness of breath.

  • Diarrhea.

  • Nausea.

  • Vomiting.

  • Tightness in the chest.

  • Anxiety.

  • Restlessness.

  • Fainting.

  • Abnormal heartbeat.

  • Dizziness.

  • Sharp stabbing kind of pain in the chest.

  • Palpitations.

  • Swelling in the ankles, legs, and feet.

  • Pressure feeling in the chest.

  • Tachycardia.

  • Bradycardia.

  • Atrial fibrillation.

  • Sore throat.

  • Joint pain.

  • Extended neck veins.

  • Decreased urine output.

  • Chest pain that radiates to the neck and left shoulder.

  • Deep inhalation turns strenuous.

  • Cold and clammy skin.

  • Heart palpitations.

  • Lightheadedness.

What Are the Causes of Pericardial Effusion?

Pericardial effusion is caused by several underlying cardiovascular conditions. Inflammation of the pericardial sac is one of the most common causes of the accumulation of extra fluid in the sac. During a viral infection, the body releases cells to kill the virus. In case these cells enter the heart, they may inflame the heart tissues leading to pericardial effusion.

Mentioned below are a few causes of pericardial effusion :

  • Coxsackie B virus.

  • EBV or Epstein-Barr virus.

  • CMV or Cytomegalovirus.

  • Herpes simplex virus.

  • Human immunodeficiency virus.

  • Hepatitis C.

  • Parvovirus.

  • Chlamydia.

  • Streptococcal bacterial infection.

  • Mycoplasma infection.

  • Treponema infection.

  • Borrelia infection.

  • Toxins such as alcohol and drugs like cocaine.

  • Lead toxin.

  • Toxins released after spider bites.

  • Wasp stings.

  • Toxins after a snakebite.

  • Chemotherapy.

  • Radiation therapy.

  • Allergies to certain medications and antibiotics.

  • Graves disease.

  • Postpartum cardiomyopathy.

  • Allergic reaction to tetanus toxoid.

  • Toxoplasmosis.

  • Giant cell disease.

  • Swelling of the pericardium post a heart attack.

  • Reaction to certain medications.

  • Autoimmune and metabolic diseases such as hypothyroidism and chronic kidney failure.

  • Radiation therapy.

How to Diagnose Pericardial Effusion?

The correct diagnosis of pericardial effusion is made after the healthcare provider has taken a thorough medical history, especially cardiovascular history. In addition, understanding the patient’s symptoms and conducting physical examinations as well as several tests are necessary to diagnose a case of pericardial effusion.

Mentioned below are some of the go-to diagnostic tools for pericardial effusion,

  • Electrocardiogram.

  • Cardiac enzyme markers.

  • Complete blood picture.

  • Echocardiogram.

  • Rheumatological screening tests.

  • Viral blood tests.

  • Heart muscle biopsy.

  • Chest x-rays.

  • Lung and other chest structures examination.

  • MRI of the heart or magnetic resonance imaging of the heart.

Can Pericardial Effusion Be Prevented?

The risk of experiencing a pericardial effusion can be reduced by eating a healthy diet and exercising regularly. A balanced diet acts as fuel to the heart providing all the necessary nutrients, while regular exercise keeps the heart running similar to an engine. Depriving the heart of these two basic and fundamental requisites will only call for trouble in the near or late future. If one is already suffering from other cardiovascular diseases, a heart-healthy diet and regular consultations with the cardiologist should be made a priority.

How to Treat Pericardial Effusion?

The exact treatment of pericardial effusion depends on its severity. In case there is only a little amount of fluid, any particular treatment is not required.

Mentioned below are the treatment modalities of pericardial effusion,

  • NSAIDs or nonsteroidal anti-inflammatory drugs.

  • Corticosteroids.

  • Colchicine.

  • Pericardiocentesis or drainage of excess fluid in the cardiovascular system.

  • Pericardial window.

How Long Will It Take to Recover After Treatment?

The following factors will determine the time it takes for recovery after treatment-

  • The reason for the effusion.

  • The severity.

  • The kind of treatment.

What Are the Complications of Pericardial Effusion?

Pericardial effusion can be understood as a medical condition in which blood or fluid penetrates inside the pericardium resulting in central pressure on the heart. This penetration does not allow the heart to pump blood or function appropriately. Due to less or no blood supply from the heart, vital organs start to fail one after the other, and the body goes into shock. Regular electrocardiograms are taken to monitor the functioning of the heart. Analgesics and anti-inflammatory drugs are administered or prescribed to be taken routinely. In case of open-heart surgery or any invasive procedure, a blood transfusion may be required. Your healthcare provider is the right person to determine the principal line of treatment since each and every case of pericardial effusion are divergent on its own.

What Is the Prognosis of Pericardial Effusion?

Based on the cause and intensity of pericardial effusion, it can be cured. Pericardial effusion without any known cause generally has a good prognosis. If it occurs due to trauma or cancer, it is quite harder to treat and may cause complications. Individuals with pericardial effusion due to cancer or HIV (human immunodeficiency virus) have poor survival rates.

How Can I Take Care of Myself?

One must follow the instructions and medications provided by the physician. Furthermore, individuals must have a keen observation of their bodily symptoms and overall health.

What Distinguishes Pleural Effusion From Pericardial Effusion?

Both are the same except for the location. The pleural cavity is the space surrounding the lungs, and pleural effusion is the fluid buildup around them. This fluid buildup prevents the expansion of the lungs and makes it challenging to breathe.

Conclusion:

An episode of pericardial effusion results from fluid lodgement within the pericardium, which is the protective and lubricative sac surrounding the heart. Pericardial effusion is a medical emergency that demands instantaneous relief from pain and prompt treatment measures. Drainage of the assembled fluid within the heart’s cavity is an unavoidable management modality, which is generally invasive in nature. The outlook after treatment is satisfactorily acceptable. But this is conditional on the diagnosis being made in the nick of time. Pericardial effusion is indeed a medical crisis that puts both the patient and their family as well as the treating doctor into a tight spot. Nevertheless, it is a reversible condition that may result in a positive outlook.

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Frequently Asked Questions

Pericardial effusion is a condition in which there is a collection of fluid in the pericardium, the fibrous sac that covers the heart. This condition can put pressure on the heart, which will affect the working of the heart. If this condition is left untreated, this can cause some serious complications such as heart failure or death.
Pericardial effusion may be small or large. The smaller effusions may not need treatment and go away on their own. The severity of this condition does not depend on the cause, the amount of fluid accumulated in the pericardium, and how fast that fluid fills up in the pericardium.
Pericardial effusion usually occurs from the inflammation of the pericardium due to any illness or injury. Moreover, in some cases, large effusions may occur due to lung cancers. Lung cancer is considered one of the primary causes of malignant pericardial effusion. Other than that, blockage of pericardial fluids or collection of blood within the pericardium may also lead to this condition.
An electrocardiogram (ECG) is a noninvasive simple diagnostic test that is used to check the heart rhythm and electrical activity of the heart. There have been some reports regarding the ECG changes in association with pericardial effusion, which are based on a small amount of data. The changes include P wave changes, T wave inversion, and QRS voltage electrical alterations.
The management of pericardial effusion usually depends upon the type of etiology. The initial step of managing pericardial effusion is draining excess fluid (pericardiocentesis), and medications such as Nonsteroidal anti-inflammatory drugs (NSAIDs) can be prescribed. In case this pericardiocentesis procedure is not feasible, another surgical method can also be used.
The pericardial effusion can be controlled or prevented by following some of the following steps such as -
 - Reducing stress.
 - Resting.
 - Eat an anti-inflammatory diet such as 
 - Raw fruits and vegetables.
 - Eating probiotic-rich foods such as cultured vegetables (like sauerkraut and kimchi), kombucha, coconut kefir, and cultured yogurt.
 - Eating high-quality protein food.
 - Consume healthy fats such as coconut oil, olive oil, avocado, nuts, and seeds.
 - Drink plenty of water daily.
 - Quit smoking.
 - Taking natural sleep aids and pain-relievers.
The pericardial effusion fluid can be removed with the help of a surgical procedure called pericardiocentesis. In this procedure, the healthcare provider will use a needle that is inserted in the pericardial space, and after that, a small tube (catheter) is used to drain the fluid from the pericardium. Multiple imaging tools can be used to perform this procedure, such as echocardiography. The catheter is usually left there to drain all the excess fluid.
Certain prescription drugs can also lead to pericardial effusion, which includes -
 - Hydralazine is a medication for high blood pressure.
 - Isoniazid is a drug used in tuberculosis.
 - Phenytoin is a medication for epileptic seizures.
 - Chemotherapy drugs such as Doxorubicin and Cyclophosphamide.
There are multiple risk factors that can lead to pericardial effusion, which include -
 - Autoimmune conditions such as rheumatoid arthritis.
 - Cancer of the heart or pericardium.
 - Radiation therapy for cancer
 - Trauma to the chest.
 - Underactive thyroid (hypothyroidism).
 - Inflammation of the pericardium.
 - Infections such as viral, bacterial, fungal, or parasitic. 
 - Use of certain drugs or exposure to toxins.
The malignant pericardial effusion is a common manifestation. This is seen in around 12 to 23 percent of cases with pericarditis and pericardial effusion. The origin is the initiation of malignant processes, including solid tumors or hematological malignancies. This is a serious manifestation that can even lead to death without any treatment.
According to various studies, there have been several reported cases of pericardial effusion in COVID-19 patients. It has been found that there is around 22 percent of pericardial effusion cases can be found in COVID-19 patients after testing positive on an RT-PCR (real-time reverse transcription-polymerase chain) test.
The treatment of pericardial effusion usually depends upon the severity of the condition or fluid buildup. However, it can be treated with certain medicines, such as Nonsteroidal anti-inflammatory drugs (NSAIDs), which help in reducing the inflammation of the pericardium. But if the healthcare provider finds that it is necessary to drain the excess fluid, then surgery has to be done to treat the condition.
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Dr. Sapkal Ganeshrao Patilba from iCliniq
Dr. Sapkal Ganeshrao Patilba

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