Pericardial Effusion and Pericardial Tamponade

Pericardial Effusion refers to an abnormal accumulation of fluid in the pericardial cavity (the layer surrounding the heart). There is limited amount of space in the pericardial cavity, and if sufficient fluid accumulates, it can lead to an increase in the intra-pericardial pressure, and reduce normal ventricular filling. Pericardial effusions can be acute or chronic, and

When a large enough volume of fluid accumulates such that ventricular filling is compromised, it is referred to as “cardiac tamponade”.

What Can Cause Pericardial Effusions?

• Pericarditis

• Certain infections

• Renal failure

• Heart surgery

• Inflammatory disorders, such as lupus

• Post-myocardial infarction pericarditis (known as Dressler’s syndrome)

• Cancer that has spread to the pericardium

What are the Symptoms of Pericardial Effusion?

Clinical manifestations of pericardial effusion are highly dependent on the rate of accumulation of fluid in the pericardial space. The faster the rate of accumulation, the small the volume of fluid required to cause symptoms.

A small pericardial effusion may have no symptoms at all. Larger effusions may present with chest pain or pressure symptoms. Typically, pericardial pain is relieved by sitting up and leaning forward, and made worse by lying down in a supine position.

There may also be signs of cardiac compromise, such as light-headedness, fainting spells, breathlessness, palpitations, swelling of the feet and ankles etc.

How are Pericardial Effusions Diagnosed?

After conduction a clinical interview, your doctor will perform a thorough physical examination to look out for the following signs:

• Beck’s Triad of pericardial tamponade: (i) muffled heart sounds, (ii) raised jugular venous pressure, (iii) hypotension.

• Pericardial friction rub: when pericarditis is present, a high-pitched grating sound is sometimes heard. This sound is heard most frequently during expiration and when the patient is upright and leaning forward.

• Pulses paradoxus and widened pulse pressure

• Signs of congestive heart failure such as raised jugular venous pressure, edema of the lower extremities etc

Investigations:

Chest X-ray: shows an enlarged cardiac silhouette, may also show pleural effusion.

Electrocardiogram: electrical voltages are observed to be lower than normal.

Echocardiogram: pericardial effusions appear as an “echo-free” space between the pericardial layers.

Pericardiocentesis: this procedure is used for both diagnostic as well as therapeutic purposes. Basically, a needle is inserted into the pericardial space, and the fluid is withdrawn. This immediately relieves the intra-pericardial pressure, and the fluid can also be sent for laboratory testing.

How are Pericardial Effusions Treated?

Treatment will depend on the underlying cause, as well as the severity of impairment of cardiac function. Pericardial effusions due to a viral etiology often spontaneously resolve after a few weeks, even without treatment. Pericardial effusions due to inflammatory conditions such as lupus are often treated with anti-inflammatory agents.

If cardiac function is impaired due to the effusion, then the pressure may be relieved with pericardiocentesis, or surgical creation of a pericardial window.