Heart Disease Health Center

Pericardial Effusion

A pericardial effusion is an abnormal amount of fluid between the heart and the pericardium, which is the sac surrounding the heart. Pericardial effusions are associated with many different medical conditions. Most pericardial effusions are not harmful, but large pericardial effusions can cause problems by impairing heart function.

The pericardium is a tough, layered sac that wraps around the heart. When the heart beats, it slides easily within the sac. Normally, only 2 to 3 tablespoons of clear-yellow pericardial fluid are present between two layers, which lubricates the heart's movements within the sac.

In pericardial effusions, significantly larger amounts of pericardial fluid accumulate. Small pericardial effusions may contain 100 milliliters of fluid. Very large pericardial effusions may involve more than two liters of fluid.

Causes of Pericardial Effusion

Most pericardial effusions are caused by inflammation of the pericardium, a condition called pericarditis. As the pericardium becomes inflamed, extra fluid is produced, leading to a pericardial effusion.

Viral infections are one of the main causes of pericarditis and pericardial effusions. Infections causing pericardial effusions include cytomegalovirus, coxsackieviruses, echoviruses, and HIV.

Other conditions that can cause pericardial effusions include:

• Cancer
• Injury to the pericardium or heart from a medical procedure
• Heart attack (myocardial infarction)
• Uremia (severe kidney failure)
• Autoimmune disease (lupus, rheumatoid arthritis, and others)
• Bacterial infections, including tuberculosis

In a large number of people with pericardial effusion, no cause can be identified. These are called idiopathic pericardial effusions.

Symptoms of Pericardial Effusion

When a pericardial effusion is caused by pericarditis, the main symptom is chest pain. The chest pain may be made worse by deep breathing and lessened by leaning forward. When pericarditis is causing a pericardial effusion, other symptoms may include:

• Fever
• Fatigue
• Muscle aches
• Shortness of breath
• Nausea, vomiting, and diarrhea (if viral illness is present)

In people with a pericardial effusion that's not due to pericarditis, there are often no symptoms.

Large, serious pericardial effusions may cause symptoms including:

• Shortness of breath
• Palpitations (sensation that the heart is pounding or beating fast)
• Light-headedness or passing out
• Cool, clammy skin

A pericardial effusion causing these symptoms is a medical emergency and may be life-threatening.

Diagnosis of Pericardial Effusion

Because pericardial effusions often cause no symptoms, they are frequently discovered after routine tests are abnormal. Various tests can suggest the possibility of a pericardial effusion:

Physical examination : A doctor may occasionally hear abnormal sounds over the heart that suggest pericarditis. However, doctors cannot reliably detect pericardial effusions by examination.

Electrocardiogram (ECG): Electrodes placed over the chest produce a tracing of the heart's electrical activity. Certain patterns on ECG can suggest a pericardial effusion or pericarditis is present.

Chest X-ray film: The heart's silhouette on a chest X-ray film may be enlarged, suggesting a pericardial effusion could be present.