What are the history findings suggestive of pericardial effusion?

From the Guidelines

History findings suggestive of pericardial effusion include chest pain, shortness of breath, fatigue, and a feeling of fullness in the chest, which can be diagnosed using transthoracic echocardiography as the first-line imaging test, as recommended by the 2015 ESC guidelines 1.

Key Symptoms

• Chest pain that worsens when lying flat and improves with sitting forward
• Shortness of breath
• Fatigue
• A feeling of fullness in the chest
• Palpitations, cough, hoarseness, hiccups, or difficulty swallowing due to compression of nearby structures

Relevant Medical History

• Recent viral illness, tuberculosis, cancer, kidney failure, autoimmune disorders, or chest trauma
• Recent cardiac procedures, radiation therapy, or medications like hydralazine, procainamide, or certain chemotherapeutic agents

Diagnostic Approach

• Transthoracic echocardiography is the first-line imaging test for diagnosing pericardial effusion, as it accurately detects pericardial effusion and cardiac tamponade, as well as ventricular dysfunction due to myocardial involvement 1
• The size of pericardial effusion on two-dimensional echocardiography is qualitatively assessed by the end-diastolic distance of the echo-free space between the epicardium and parietal pericardium: small (<10 mm), moderate (10–20 mm), large (>20 mm) 1
• A first diagnostic evaluation is recommended with auscultation, ECG, transthoracic echocardiography, chest X-ray, and routine blood tests, including markers of inflammation, as stated in the 2015 ESC guidelines 1

From the Research

History Findings Suggestive of Pericardial Effusion

The diagnosis of pericardial effusion can be suggested by various history findings, including:

• Acute inflammatory signs such as chest pain, fever, and pericardial friction rub, which are predictive of acute idiopathic pericarditis 2
• Severe effusion with absence of inflammatory signs and absence of tamponade, which is predictive of chronic idiopathic pericardial effusion 2
• Tamponade without inflammatory signs, which is predictive of neoplastic pericardial effusion 2
• Epidemiologic considerations, such as the prevalence of tuberculous pericarditis in underdeveloped geographic areas 2

Clinical Presentation

The presentation of a patient with a pericardial effusion can range from an incidental finding to a life-threatening emergency 3. The clinical presentation can include:

• Dyspnea
• Tachycardia
• Jugular venous distension
• Pulsus paradoxus
• Arterial hypotension and shock in severe cases 2

Etiologies

Pericardial effusions can be caused by various etiologies, including:

• Inflammatory etiologies such as acute idiopathic pericarditis and tuberculous pericarditis 3, 2
• Non-inflammatory etiologies such as neoplastic pericardial effusion 3, 2
• Idiopathic pericardial effusion, which is the most common etiology in developed countries 2

Diagnostic Evaluation

The diagnostic evaluation of pericardial effusion includes:

• Echocardiography, which is essential to define the location and size of the effusion 3
• Right heart catheterization, which can assess the severity of the pericardial effusion 4
• Pericardiocentesis, which can be performed to drain the pericardial fluid and relieve tamponade 4, 3, 2