From the Guidelines
Pericardial effusion typically presents with symptoms such as chest pain, shortness of breath, fatigue, and a feeling of fullness in the chest, which can vary in severity based on the amount of fluid and the rate of accumulation, as noted in studies 1. The symptoms of pericardial effusion can be attributed to the accumulation of fluid in the pericardial space, which restricts normal heart filling and function, reducing cardiac output. Some key signs and symptoms include:
- Chest pain, often sharp and worsened by deep breathing or lying flat
- Shortness of breath
- Fatigue
- Feeling of fullness in the chest
- Muffled heart sounds
- Elevated jugular venous pressure
- Pulsus paradoxus, an abnormal decrease in systolic blood pressure during inspiration
- Tachycardia
- Low-grade fever
- Peripheral edema In large or rapidly accumulating effusions, cardiac tamponade can develop, causing hypotension, distant heart sounds, and Beck's triad (hypotension, jugular venous distention, and muffled heart sounds), as described in 1. The diagnosis of pericardial effusion and cardiac tamponade can be confirmed using echocardiography, which is the imaging modality of choice, as stated in 1. The severity of symptoms correlates with both the volume of fluid and the speed of accumulation, with even small amounts causing significant symptoms if they develop rapidly, highlighting the importance of prompt diagnosis and treatment, as emphasized in 1. Overall, the presentation of pericardial effusion can vary widely, and a high index of suspicion is necessary to diagnose and manage this condition effectively, as noted in 1.
From the Research
Signs and Symptoms of Pericardial Effusion
- The accumulation of pericardial fluid can lead to cardiac tamponade, a medical emergency characterized by hypotension, increased jugular venous pressure, and distant heart sounds (Beck triad) 2
- Patients with pericardial effusion may experience dyspnea, orthopnoea, weakness, fatigue, tachycardia, and oliguria 2
- In cases of tamponade caused by acute pericarditis, patients may also exhibit fever and typical chest pain that increases on inspiration and radiates to the trapezius ridge 2
- Pericardial effusions can present with a range of symptoms, from incidental findings to life-threatening emergencies, and can be caused by various inflammatory and non-inflammatory etiologies 3
- Echocardiography is essential for defining the location and size of the effusion, and for assessing the hemodynamic impact of the effusion 3
Clinical Findings
- Key clinical findings in patients with cardiac tamponade include hypotension, increased jugular venous pressure, and distant heart sounds (Beck triad) 2
- Echocardiography can provide insight into the pathophysiologic alterations, primarily through an assessment of chamber collapse, inferior vena cava plethora, and marked respiratory variation in mitral and tricuspid inflow 3
- Pericardiocentesis is performed in patients with tamponade, preferably with echocardiographic guidance, and may also be performed in patients with large effusions but no tamponade if there is concern for a bacterial infection 3
Diagnosis and Management
- Numerous imaging techniques are utilized to evaluate pericardial effusion, including chest X-ray, electrocardiogram, transthoracic echocardiography, computed tomography scan, cardiac magnetic resonance imaging, and pericardiocentesis 4
- Treatment options for pericardial effusion include pericardiocentesis, pericardial window, and sclerosing therapies, as well as medical management with non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine 5, 4
- Recent recommendations from the American Society of Echocardiography and the European Society of Cardiology have improved the management of patients with pericardial effusion and cardiac tamponade, but significant knowledge gaps remain 6