Pericardial Effusion
Cardio-thoracic Surgery
The pericardium is a double-layered sac that surrounds the heart. Normally, the pericardial cavity contains about 15–50 ml of fluid to lubricate the heart's movements.
Pericardial effusion refers to the abnormal accumulation of fluid in this space. If the fluid accumulates excessively or rapidly, it can compress the heart and lead to a life-threatening condition called cardiac tamponade.
Symptoms
Symptoms vary depending on the volume and rate of fluid accumulation:
- Chest tightness or dull chest pain
- Shortness of breath, worse when lying down
- Palpitations (rapid heartbeat)
- Cough
- Fatigue, weakness
- Neck vein distension (signs of tamponade)
- Low blood pressure or even shock in severe cases (signs of tamponade)
Causes
Pericardial effusion may result from various medical conditions, including:
- Infections – viral, bacterial, or tuberculous pericarditis
- Autoimmune diseases – e.g. lupus, rheumatoid arthritis
- Cancers – especially lung cancer, breast cancer, and lymphoma
- Kidney failure – uremic pericarditis
- Post-myocardial infarction syndrome
- Trauma or post-cardiac surgery
- Drug reactions
- Idiopathic – no identifiable cause
Risk Factors
- Chronic kidney disease
- Autoimmune disease
- History of malignancy
- Recent cardiac surgery or catheterization
- Long-term anticoagulant use
- Tuberculosis (still a notable cause in Hong Kong)
Diagnosis
- Physical Examination – muffled heart sounds, jugular venous distension, hypotension (Beck’s triad)
- Electrocardiogram (ECG) – low voltage or electrical alternans
- Chest X-ray – enlarged cardiac silhouette
- Echocardiogram – the gold standard to visualise effusion and tamponade
- CT or MRI – better anatomical delineation
- Pericardiocentesis – fluid analysis for suspected infection or malignancy
Treatments
| Mild or Asymptomatic Effusions |
|
Moderate or Symptomatic Effusions | Medications: antibiotics, antivirals, corticosteroids, depending on the cause Diuretics (in select cases) |
Large or Tamponade Cases | Emergency pericardiocentesis – to relieve pressure Surgical intervention – pericardial window or pericardiectomy to prevent recurrence |
FAQ
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