From the Guidelines
Pericardial effusion signs and symptoms are primarily characterized by dyspnea, cough, chest pain, tachycardia, and jugular venous distension, with more severe cases presenting with pulsus paradoxus, hypotension, and cardiogenic shock.
Key Signs and Symptoms
- Dyspnea
- Cough
- Chest pain
- Tachycardia
- Jugular venous distension
- Pulsus paradoxus
- Hypotension
- Cardiogenic shock These symptoms typically occur when the volume of fluid exceeds 500 ml, as noted in patients with neoplastic pericarditis 1.
Diagnostic Findings
The diagnosis of pericardial effusion and cardiac tamponade is based on clinical signs, electrocardiogram (ECG) findings, and imaging studies such as echocardiography, which is the single most useful diagnostic tool to identify pericardial effusion and estimate its size, location, and degree of hemodynamic impact 1.
Echocardiographic Features
Echocardiography can identify signs of tamponade, including:
- Swinging of the heart
- Early diastolic collapse of the right ventricle
- Late diastolic collapse of the right atrium
- Abnormal ventricular septal motion
- Exaggerated respiratory variability in mitral inflow velocity
- Inspiratory decrease and expiratory increase in pulmonary vein diastolic forward flow
- Respiratory variation in ventricular chamber size, aortic outflow velocity (echocardiographic pulsus paradoxus) and inferior vena cava plethora 1.
Clinical Considerations
It is essential to note that patients with small malignant effusions are often asymptomatic, and the onset of symptoms occurs when the volume of fluid exceeds 500 ml 1. Additionally, pericardial effusion can be caused by non-malignant diseases, such as radiation pericarditis or opportunistic infections, even in patients with documented malignancy 1.
From the Research
Signs and Symptoms of Pericardial Effusion
The signs and symptoms of pericardial effusion can vary depending on the rate of fluid accumulation and the presence of cardiac tamponade. Some common signs and symptoms include:
- Dyspnea on exertion, ranging from mild to severe 2
- Chest pain, which can be position and respiratory dependent 3
- Pericardial friction rub on cardiac auscultation 4, 3
- Fever and acute inflammatory signs 5
- Jugular venous distension, pulsus paradoxus, and arterial hypotension in cases of cardiac tamponade 5, 6
- Shock due to cardiac tamponade in severe cases 2
Diagnostic Criteria
Diagnosis of pericardial effusion requires a combination of clinical signs, electrocardiography abnormalities, and echocardiography findings. Some key diagnostic criteria include:
- New or worsening pericardial effusion on echocardiography 4
- Characteristic pleuritic chest pain 4
- Pericardial friction rub on cardiac auscultation 4, 3
- Electrocardiographic changes, including new, widespread ST elevations or PR depressions 4, 3
- Cardiac chamber collapses and characteristic alterations in respiratory variations of mitral and tricuspid flow on echocardiography 5, 2
Echocardiography Findings
Echocardiography is a crucial diagnostic tool for pericardial effusion, allowing for the visualization of the excess fluid in the pericardial cavity. Some key echocardiography findings include:
- An echo-free space between the heart and the parietal layer of the pericardium 2
- Semi-quantification of the pericardial effusion by measuring the distance between the two pericardial layers 2
- Characterization of the fluid, with unechogenic space usually associated with serous fluid, and corpuscolated/echogenic fluid suggesting hemorrhagic or purulent effusions 2
- Signs of cardiac tamponade, including cardiac chambers collapse, opposite changes in right and left cardiac chamber filling during respiratory cycle, and inferior vena cava and hepatic vein plethora 2