Pericardial Effusion

Introduction

Pericardial effusion is the accumulation of excess fluid in the pericardial sac, the double-layered membrane surrounding the heart. This condition can range from mild to severe and may lead to complications such as cardiac tamponade, a life-threatening emergency.

Causes

Pericardial effusion can have various underlying causes, including: - Infections (viral, bacterial, or fungal pericarditis) - Autoimmune diseases (e.g., lupus, rheumatoid arthritis) - Cancer (primary pericardial malignancies or metastases) - Kidney failure (uremic pericarditis) - Hypothyroidism - Post-cardiac surgery or trauma - Idiopathic causes (unknown origin)

Symptoms

The severity and presentation of symptoms depend on the size and speed of fluid accumulation: - Mild cases: May be asymptomatic or cause mild chest discomfort. - Moderate to severe cases: Symptoms may include: - Chest pain (worse when lying down, relieved by sitting forward) - Shortness of breath - Fatigue - Swelling in the legs or abdomen - Low blood pressure (if tamponade develops)

Diagnosis

Common diagnostic tools include: - Echocardiography (key imaging test) - Electrocardiogram (ECG) (may show electrical alternans) - Chest X-ray (enlarged heart silhouette in severe cases) - CT or MRI (useful for further evaluation in complex cases) - Pericardial fluid analysis (if infection, malignancy, or autoimmune disease is suspected)

Treatment

Treatment depends on the cause and severity of the effusion: - Mild cases may require only monitoring. - Medical therapy (anti-inflammatory drugs, corticosteroids, antibiotics if infectious origin). - Pericardiocentesis (drainage with a needle in large or symptomatic effusions). - Surgical intervention (pericardial window or pericardiectomy in recurrent cases).

Conclusion

Pericardial effusion is a potentially serious condition requiring careful evaluation and management. If left untreated, it can progress to cardiac tamponade, which demands emergency intervention.

Source recommendations

1. 2021 ESC Guidelines for the Diagnosis and Management of Pericardial Diseases

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Pericardial-Diseases-Guidelines-on-the-Diagnosis-and-Management-of
2. https://pubmed.ncbi.nlm.nih.gov/26320112/
3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
4. https://pubmed.ncbi.nlm.nih.gov/33825853/
5. https://academic.oup.com/eurheartj/article/42/16/1554/6212698

2. ACC/AHA Guidelines on Pericardial Diseases

1. https://www.sciencedirect.com/science/article/abs/pii/S1936878X24001608
2. https://www.jacc.org/doi/10.1016/j.jacc.2019.11.021
3. https://www.ahajournals.org/doi/full/10.1161/circulationaha.105.561514
4. https://academic.oup.com/eurheartj/article/36/42/2921/2293375
5. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2015/10/30/12/01/2015-esc-guidelines-for-the-diagnosis-and-management-of-pericardial-diseases