A pericardial effusion is extra fluid in the sac around the heart, from causes such as viral pericarditis, cancer, kidney failure, hypothyroidism or trauma. If fluid builds up fast or becomes large, it can squeeze the heart and cause cardiac tamponade.
Key symptoms
- Often no symptoms when small or slow
- Chest pressure or fullness
- Shortness of breath, worse lying down
- Cough, hoarseness or trouble swallowing from pressure on nearby structures
What you find on exam
- Muffled heart sounds
- Raised jugular venous pressure
- Pulsus paradoxus over 10 mmHg
- Low blood pressure and fast heart rate in tamponade
Tests
- Echocardiogram: size of the effusion and collapse of the right heart chambers
- ECG: low voltage, electrical alternans
- Chest X-ray: enlarged, water-bottle shaped heart
- Search for the cause: TSH, kidney function, CRP, cancer workup; fluid analysis if drained
Treatment basics
- Treat the cause; NSAIDs and colchicine if pericarditis
- Watch small stable effusions with repeat echo
- Pericardiocentesis for tamponade or large effusions
- Pericardial window for recurrent effusions
Red flags
- Low blood pressure, distended neck veins and muffled heart sounds (Beck triad)
- Rapidly worsening breathlessness
- Effusion after chest trauma or a cardiac procedure
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.