What Is Pericardial Effusion?

Excess Fluid Around the Heart

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Pericardial effusion is when the sac around the heart, called the pericardium, fills with extra fluid. It is normal for a thin layer of fluid to be inside the pericardium. However, too much fluid around the heart can put pressure on the organ and impact its function.

This condition is relatively common. It can develop slowly and have few or no symptoms. However, in some cases, it can develop rapidly and become life-threatening. Causes include infection, inflammatory conditions, trauma, and cancer. Treatment depends on how much fluid is present and the underlying cause.

In this article, you will learn about the causes, symptoms, diagnosis, treatments, and prognosis of pericardial effusion.

Man clutching his hands to his chest

manusapon kasosod / Getty Images

Pericardial Effusion Symptoms

Most people with a small pericardial effusion will have no symptoms caused by the effusion itself. It may be found incidentally during imaging for other reasons.

You might experience symptoms due to the underlying cause of the pericardial effusion. For example, if an infection causes pericardial effusion, you may have a fever and chills.

Symptoms of a larger pericardial effusion that is impacting the ability of the heart to pump blood effectively include:

The time the effusion takes to develop can also influence symptoms, as follows:

  • Acute: Develops rapidly in less than a week
  • Subacute: Develops over one week to three months
  • Chronic: Develops over more than three months

Cardiac Tamponade and Cardiogenic Shock

In severe cases, pericardial effusion can lead to cardiac tamponade. Cardiac tamponade occurs when the buildup of pericardial fluid is enough to seriously compromise heart function. Cardiac tamponade is a medical emergency.

A severe effusion or cardiac tamponade can lead to the heart being unable to fill with blood to pump it out to the body. This results in cardiogenic shock (extremely low blood pressure), which can lead to organ failure or death. Shock is a medical emergency requiring immediate treatment.

Signs of cardiogenic shock include:

  • Light-headedness
  • Rapid breathing
  • Pale and/or clammy skin
  • Arms and legs may feel cold
  • Little urine production
  • Confusion

When to Call 911

If you experience pain in your chest, back, neck, or shoulder, or significant difficulty breathing, call 911 or seek immediate medical attention.

Causes

A pericardial effusion can develop due to many conditions, injuries, or medication or medical treatment side effects. It can be caused by inflammation, a blockage of pericardial fluids, or blood collecting in the pericardium. Sometimes, the underlying cause remains a mystery.

A pericardial effusion often develops due to pericarditis, in which the pericardium becomes inflamed. This can happen in many conditions, but it is often due to a viral infection, such as those that cause a chest cold or pneumonia. Bacterial infections, such as tuberculosis, may also be a cause. Rarely, it might be caused by a fungal or parasitic infection.

Conditions that may produce a pericardial effusion, some due to inflammation and some without inflammation, include:

  • Cancer, including of the heart or pericardium, leukemia, lymphoma, metastatic lung cancer, metastatic breast cancer
  • Cancer treatments, such as radiation when the heart is in the radiation field or chemotherapy (especially doxorubicin or cyclophosphamide)
  • Autoimmune diseases, such as lupus or rheumatoid arthritis
  • Hypothyroidism (underactive thyroid gland)
  • Renal disease or kidney failure
  • Traumatic injuries, including those due to heart surgery or procedures on the heart
  • Heart attack (myocardial infarction)
  • Medication side effects, such as from the blood pressure medication hydralazine, tuberculosis drug isoniazid, and anti-seizure drug Dilantin (phenytoin)

Males aged 16 to 65 are at the highest risk for pericarditis, but it can happen to people of all ages.

What Is Malignant Pericardial Effusion?

Malignant pericardial effusion is excess fluid around the heart due to cancer. It most often occurs with lung cancer, breast cancer, or blood cancers.

Diagnosis

A small pericardial effusion may have no symptoms, but it might be suspected or seen with imaging if you seek medical care for another reason. If you have symptoms, a healthcare provider will perform an examination, imaging, and tests to find the cause.

Your healthcare provider will use a stethoscope to listen to your heart. Inflammation of the pericardium often associated with pericardial effusions can cause a scraping sound, called a pericardial rub, produced by inflamed pericardial membranes moving against one another as the heart beats.

Other tools to diagnose pericardial effusion include:

  • Echocardiogram: This is an ultrasound of the heart. It is a reliable and available method to diagnose pericardial effusion and its severity.
  • Electrocardiogram: This test evaluates your heart's electrical system. It may show changes that suggest the presence of pericardial effusion.
  • Chest X-ray or magnetic resonance imaging (MRI): These imaging techniques help your provider visualize your chest and may discover a pericardial effusion incidentally or suggest its presence.
  • Heart magnetic resonance imaging (MRI) or computed tomography (CT) scan: These imaging techniques help your provider visualize your heart.

You may also need a troponin blood test to check your heart for muscle damage. Troponin is a protein in the heart muscles but not in the blood. If troponin is in your blood, it indicates that your heart muscle has some damage. Higher levels of troponin mean more severe heart damage.

Additional tests that your healthcare provider may order include:

  • Antinuclear antibody (ANA): Blood testing for evidence of autoimmune disease
  • Blood culture: Blood testing for the presence of bacteria
  • C-reactive protein: Blood testing for inflammation markers
  • Rheumatoid factor: Blood testing for a specific protein that indicates certain autoimmune diseases
  • Tuberculin skin test: Skin testing for an immune response to the bacterium that causes tuberculosis

How Do You Treat Pericardial Effusion?

The most important step in treating pericardial effusion is identifying and treating the underlying cause. Depending on the cause, a small pericardial effusion can go away on its own. A healthcare provider may opt to monitor it while treating any underlying conditions.

A healthcare provider may use nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and colchicine medication to reduce swelling in the pericardium. If an underlying bacterial infection causes the pericardial effusion, the first line of treatment may be antibiotics.

If the fluid around the heart is impeding its function, draining the fluid using a needle (pericardiocentesis) is often performed. The fluid can be further analyzed to determine the underlying cause. This procedure might need to be repeated if more fluid accumulates.

In some cases, surgery may create a window in the pericardium so the fluid can drain internally rather than pool in the pericardium.

Does Pericardial Effusion Go Away?

Pericardial effusion can be mild to severe, depending on the cause. Outcomes are good for viral or idiopathic (cause unknown) pericarditis if the condition is treated right away. After treatment begins, most people recover in two weeks to three months.

When pericardial effusion is severe or goes untreated, heart tissue may become damaged, causing a condition called restrictive pericarditis, which can cause long-term issues with heart function. For those treated for acute pericarditis or pericardial effusion, about 30% will develop the condition again.

The prognosis is poor for people with fungal or bacterial pericarditis or pericardial effusion due to advanced cancer.

Summary

Pericardial effusion is when the sac around the heart, called the pericardium, fills with excess fluid. If left untreated, it can impact heart function. There are various possible causes for this condition. Your healthcare provider may use specific techniques, tests, or imaging to make a diagnosis.

Depending on the severity of the pericardial effusion, it may go away without treatment, require medication, draining, or, in severe cases, surgery. The prognosis for pericardial effusion is good if its idiopathic or viral pericarditis. If treated early, most people will recover within a few weeks. However, the prognosis is poor for people with bacterial or fungal pericarditis or malignant pericardial effusion.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Carisa Brewster
Carisa D. Brewster is a freelance journalist with over 20 years of experience writing for newspapers, magazines, and digital publications. She specializes in science and healthcare content.