From the Guidelines
Congestive heart failure (CHF) can cause pericardial effusion through a mechanism of decreased reabsorption of pericardial fluid due to increased systemic venous pressure, leading to the accumulation of a transudate.
Mechanism of Pericardial Effusion in CHF
- The normal pericardial sac contains a small amount of pericardial fluid, which acts as a lubricant between the pericardial layers 1.
- In CHF, the increased systemic venous pressure can lead to decreased reabsorption of pericardial fluid, resulting in the accumulation of a transudate 1.
- This process is distinct from the increased production of pericardial fluid (exudate) that occurs in response to inflammation or other pathological processes 1.
Clinical Significance
- Pericardial effusion can be classified according to its onset, distribution, hemodynamic impact, composition, and size 1.
- A significant proportion of patients with pericardial effusion are asymptomatic, and the effusion may be an incidental finding on imaging studies 1.
- In the context of pulmonary arterial hypertension (PAH), pericardial effusion is common and typically small in size, but can be a sign of right ventricular failure and increased right-sided filling pressures 1.
From the Research
Mechanism of Pericardial Effusion in CHF
- Congestive heart failure (CHF) can cause pericardial effusion due to elevated right-sided filling pressure in the heart 2.
- The accumulation of pericardial effusion in patients with CHF is likely related to abnormal volume/pressure relationships of the right heart, which alters venous and lymphatic drainage 3.
- Pericardial effusion forms only with elevation of the right-sided filling pressure in the heart, and not with elevated left-sided pressure alone 2.
Incidence and Characteristics of Pericardial Effusion in CHF
- The incidence of pericardial effusion in patients with CHF is around 9.92% 4.
- Most pericardial effusions in CHF patients are small to moderate in size 4.
- Pericardial effusion is not related to the etiology of CHF, but is strongly connected with higher systolic blood pressure, low left ventricular ejection fraction (LVEF), and large main pulmonary artery diameter (MPAD) 4.
Relationship between Pericardial and Pleural Effusions in CHF
- Pleural effusions are more common than pericardial effusions in CHF patients, and are typically bilateral 2, 5.
- There is no significant association between the amount of pleural effusion and the semiquantified pericardial effusion 5.
- Pericardial effusion does not increase the risk of death in patients with CHF 4.