Pericardial Fluid: Its Role, Disorders, and Management

Introduction

Pericardial fluid is a lubricating fluid located between the two layers of the pericardium—the sac that surrounds the heart. It ensures smooth movement of the heart within the chest cavity and prevents friction during contractions.

Normal Function

• Normal pericardial fluid volume: 15-50 mL
• Composition: Contains proteins, electrolytes, and immune cells
• Function: Reduces friction, allows smooth heart movement

Disorders Related to Pericardial Fluid

1. Pericardial Effusion (Excess Fluid Accumulation)

• Causes:
  • Infections (viral, bacterial, tuberculosis)
  • Autoimmune diseases (rheumatoid arthritis, lupus)
  • Cancer (lung, breast, or lymphoma spread to pericardium)
  • Kidney failure (uremic pericarditis)
  • Trauma (heart surgery or injuries)
• Symptoms:
  • Shortness of breath
  • Chest pain (often worsens when lying down)
  • Swelling in the legs
  • Fatigue
• Complications: Cardiac tamponade (dangerous compression of the heart, leading to shock or sudden death)

2. Cardiac Tamponade (Emergency Condition)

• Occurs when excess pericardial fluid prevents the heart from pumping effectively.
• Signs: Beck’s Triad (Low blood pressure, muffled heart sounds, distended neck veins)
• Immediate treatment: Pericardiocentesis (removal of fluid using a needle)

Diagnosis

• Echocardiogram (Ultrasound of the heart) – First-line test
• Electrocardiogram (ECG) – May show electrical alternans (when effusion is large)
• Chest X-ray – Enlarged cardiac silhouette
• CT scan or MRI – Detailed imaging if needed
• Pericardial fluid analysis – Determines the cause (infection, malignancy, etc.)

Treatment

• Small effusions – Monitor with regular imaging if patient is stable
• Large or symptomatic effusions – Drainage (pericardiocentesis or pericardial window surgery)
• Treatment of underlying cause – Antibiotics for infection, dialysis for kidney failure, steroids for autoimmune disease

Conclusion

Pericardial fluid is essential for normal heart function, but abnormal accumulation can be life-threatening. Early diagnosis and treatment are crucial to prevent complications like cardiac tamponade.

Source recommendations

1. American Heart Association Guidelines on Pericardial Diseases

1. https://www.ahajournals.org/doi/full/10.1161/circulationaha.105.561514
2. https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis
3. https://www.sciencedirect.com/science/article/abs/pii/S1936878X24001608
4. https://www.jacc.org/doi/10.1016/j.jacc.2019.11.021
5. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Pericardial-Diseases-Guidelines-on-the-Diagnosis-and-Management-of

2. European Society of Cardiology Guidelines on Pericardial Diseases

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Pericardial-Diseases-Guidelines-on-the-Diagnosis-and-Management-of
2. https://academic.oup.com/eurheartj/article/36/42/2921/2293375
3. https://pubmed.ncbi.nlm.nih.gov/26320112/
4. 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
5. https://pubmed.ncbi.nlm.nih.gov/15120056/