What is pericardial effusion?

A pericardial effusion is the buildup of excess fluid in the space around the heart, known as the pericardial sac. This two-layered sac that surrounds the heart normally has a small amount of fluid between its layers.

As fluid increases due to a several possible reasons, such as infection or injury, the sac can press on the heart. This pressure can keep your heart from beating as it should. You may feel chest pain, have shortness of breath or low blood pressure.

Treatment may include addressing the underlying cause of the condition and procedures to drain the excess fluid.

Without treatment, the condition can become severe — leading to heart failure or death.

Is pericardial effusion an emergency?

The severity of your pericardial effusion determines if your condition is an emergency and must be delt with immediately. Some pericardial effusions are small and may go away on their own without causing symptoms or problems for your heart. Your doctor may advise monitoring small pericardial effusions and focus treatment on an underlying cause.

A large pericardial effusion is often an emergency because the amount of excess fluid is keeping your heart from pumping normally.

You should call 911 immediately and go the nearest emergency department if you have chest pain, difficulty breathing or an unexplained fainting spell.

Pericardial effusion vs. cardiac tamponade

A pericardial effusion is the buildup of fluid around the heart — even if it poses no immediate risk or is considered mild.

Cardiac tamponade is a complication of a pericardial effusion in which the fluid buildup strains your heart so severely that your heart can’t get adequate blood supply. Cardiac tamponade can occur quickly and needs treatment immediately.

Causes of pericardial effusion

The cause of the excess fluid buildup can be caused by an underlying disease, injury, infection or another disorder. Pericardial effusion often happens along with inflammation of the pericardium (pericarditis).

Some reasons for this inflammation can include:

• Autoimmune disorders, such as rheumatoid arthritis or lupus
• Cancer
• Heart attack or after a heart surgery
• Hypothyroidism
• Infections – including HIV 
• Injury to the chest
• Uremia

Symptoms of pericardial effusion

Small pericardial effusions may not cause any symptoms at all. You’re more likely to experience symptoms when an effusion is more severe or comes on quickly.

Symptoms can mimic those of heart failure, including difficulty catching your breath, chest pain and coughing.

Other symptoms include painful breathing, fever, rapid heart rate and fainting.

If your effusion is very large, you may also experience trouble swallowing, hiccups or hoarseness.

How is pericardial effusion diagnosed?

Tests to diagnose pericardial effusion include:

• Echocardiogram (also called echo) – This test uses sound waves to assess the function and structure of the heart muscle and valves.
• Chest X-ray – A radiograph or picture of the heart and lungs including blood vessels, ribs and bones of the spine.
• Electrocardiogram (EKG/ECG) – A test that records the electrical activity of the heart.
• CT scan (computed tomography scan) – An imaging procedure that uses X-rays and computer technology to produce cross-sectional, detailed images of the body, including bones, muscles, fat and organs.
• Cardiac MRI (cardiac magnetic resonance imaging or CMR) – A noninvasive, sophisticated imaging procedure that uses large magnets and a computer to produce detailed images of the structure and function of the heart while it is beating.

Pericardial effusion treatment

If the effusion is small enough, you may not need any treatment and it may go away on its own. In other cases, treatment of pericardial effusion depends on the extent of fluid accumulated and how likely it is to make your heart work harder than normal.

Medication

Medications to treat pericardial effusion include nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin and corticosteroids.

Surgery and other procedures

Procedures to treat pericardial effusion focus on removing excess fluid and preventing it from accumulating in the future.

• Pericardiocentesis – Your doctor will insert a needle into your chest to pull out the excess fluid.
• Pericardial window surgery – This surgery creates a “window” to allow draining fluid to move into a larger area (pleural cavity) so as to not fill up the pericardial space.
• Pericardiectomy – A surgical procedure to remove all or part of the pericardium.

What can I do to prevent pericardial effusion?

It may be impossible to prevent pericardial effusion. However, you can reduce your risk of some medical problems that can lead to pericardial effusion. In general, practice heart healthy behaviors such as:

• Limiting alcohol
• Eating healthy diet
• Getting enough exercise
• Maintaining a healthy weight