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Pericardial effusion (per-e-KAHR-dee-ul uh-FU-zhun) occurs when too much fluid builds up around the heart.

The heart is surrounded by a double-layered, sac-like structure called the pericardium. The space between the layers normally contains a very small amount of fluid.

But if the pericardium is diseased or injured, the resulting inflammation can lead to pericardial effusion. Fluid can also build up around the heart without inflammation. Sometimes, pericardial effusion can be caused by the accumulation of blood after a surgical procedure or injury.

When the amount of fluid exceeds the pericardium's "full" level, pericardial effusion puts pressure on the heart, causing poor heart function. If left untreated, pericardial effusion can cause heart failure or even death.SYMPTOMS

You can have significant pericardial effusion and experience no signs or symptoms, particularly if the fluid has increased slowly.

If pericardial effusion symptoms do occur, they may include:

*Shortness of breath or difficulty breathing (dyspnea)

*Discomfort when breathing while lying down (orthopnea)

*Chest pain, usually behind the breastbone or on the left side of the chest that often feels worse when you breathe and feels better when you are sitting up, rather than lying down


*Low-grade fever

*Rapid heart rate

When to see a doctor?

Call your local emergency number if you feel chest pain that lasts more than a few minutes, if your breathing is difficult or painful, or if you have an unexplained fainting spell. If you experience shortness of breath, fatigue or other symptoms of pericardial effusion, see your doctor.


Inflammation of the pericardium (pericarditis) is a response to disease, injury or an inflammatory disorder that affects the pericardium. Pericardial effusion is often a sign of this inflammatory response.

Pericardial effusion may also occur when the flow of pericardial fluids is blocked or when blood accumulates within the pericardium. It's not clear how some diseases contribute to pericardial effusion, and sometimes the cause can't be determined.

Specific causes of pericardial effusion may include:

*Viral, bacterial, fungal or parasitic infections

Inflammation of the pericardium due to unknown cause (idiopathic pericarditis)

Inflammation of the pericardium following heart surgery or a heart attack (Dressler's syndrome)

*Autoimmune disorders, such as rheumatoid arthritis or lupus

Waste products in the blood due to kidney failure (uremia)

*Underactive thyroid (hypothyroidism))

*Spread of cancer (metastasis), particularly lung cancer, breast cancer, melanoma, leukemia, non-Hodgkin's lymphoma or 

*Hodgkin's disease

*Cancer of the pericardium or heart

*Radiation therapy for cancer if the heart was within the field of radiation

*Chemotherapy treatment for cancer, such as doxorubicin (Doxil) and cyclophosphamide (Cytoxan)

*Trauma or puncture wound near the heart

Certain prescription drugs, including hydralazine, a medication for high blood pressure; isoniazid, a tuberculosis drug; and phenytoin (Dilantin, Phenytek, others), a medication for epileptic seizures


The pericardium can hold only a limited amount of excess fluid without causing problems. The inner layer of the pericardium is made of a single layer of cells that sticks to the heart. The outer layer is thicker and only somewhat elastic. When too much liquid collects, the pericardium expands inward, toward the heart.

When pericardial effusion puts pressure on the heart, the pumping chambers of the heart fail to fill completely, and one or more chambers may partially collapse. This condition, called tamponade (tam-pon-AYD), causes poor blood circulation and an inadequate supply of oxygen to the body. Tamponade is a life-threatening condition if left untreated.


Your doctor will do a series of tests to look for pericardial effusion, identify possible causes and determine treatment. For some of the exams, your doctor may refer you to a cardiologist.

*Medical exam

Your doctor will perform a medical exam. In particular, he or she will listen to your heart with a stethoscope. If your pericardium is inflamed, your doctor may hear a high-pitched, scratchy sound called a friction rub. If there's a large amount of fluid accumulated, your heartbeat may be muffled or sound distant.


A commonly used test to diagnose pericardial effusion is an echocardiogram. An echocardiogram uses sound waves to create real-time images of your heart. With this procedure, a cardiologist can see the extent of pericardial effusion based on the amount of space present between the two layers of the pericardium. An echocardiogram can also show decreased heart function due to pressure on the heart (tamponade). Your cardiologist may be able to see whether one or more chambers of the heart have collapsed and how efficiently your heart is pumping blood. There are two types of echocardiograms:

*Transthoracic echocardiogram.

 This device uses a sound-emitting device (transducer) that is placed on your chest over your heart.

*Transesophageal echocardiogram.

 This type of echocardiogram uses a tiny transducer on a tube that's inserted down your the part of the digestive tract that runs from the throat to the stomach (esophagus). Because the esophagus lies close to the heart, having the transducer placed there often provides a more detailed image of the heart.


An electrocardiogram — also called an ECG or EKG — records electrical signals as they travel through your heart. Your cardiologist can look for patterns among these signals that suggest tamponade.

*Chest X-ray

A chest X-ray may show an enlarged silhouette of your heart if the amount of fluid in the pericardium is large.

*Other imaging technologies

Computerized tomography (CT) scan and magnetic resonance imaging (MRI) are imaging technologies that can detect pericardial effusion, although they're not generally used to look for the disorder. However, pericardial effusion may be diagnosed when these tests are done for other reasons.

*Other tests

If your doctor finds evidence of pericardial effusion, he or she may order blood tests or other diagnostic tests to identify an underlying cause.


Treatment for pericardial effusion will depend on how much fluid has accumulated, what is causing the effusion, and whether pericardial effusion has caused or is likely to cause decreased heart function due to pressure on the heart (cardiac tamponade). Treating the underlying cause of pericardial effusion often corrects the problem.

Medications that reduce inflammation

If you don't have tamponade or there's no immediate threat of tamponade.

*Other treatments

If anti-inflammatory treatments don't correct the problem, if you have tamponade or if you're at risk of tamponade, your cardiologist will likely recommend one of the following procedures to drain fluids or prevent fluids from accumulating again.

*Drain the fluid. 

Your doctor can use a needle to enter the pericardial space and then a small tube (catheter) to drain fluid from the pericardium. This procedure is called pericardiocentesis. The doctor will use imaging devices — either echocardiography or a type of X-ray technology called fluoroscopy — to guide the work. Your heart is monitored during the procedure with an ECG machine. In most cases, the catheter will be left in place to drain the pericardial space for a few days to help prevent the fluid from building up again.

*Open heart surgery.

 If there's bleeding into the pericardium, especially due to recent heart surgery or other complicating factors, you may undergo surgery to drain the pericardium and repair any related damage. Occasionally, a surgeon may drain the pericardium and create a "passage" that allows it to drain as necessary into the abdominal cavity where the fluid can be absorbed.

*Seal the layers together. 

During a procedure called intrapericardial sclerosis, a solution is injected into the space between the two layers of the pericardium that essentially seals the layers together. This procedure is usually used if you have recurring pericardial effusion or if the effusion is caused by cancer.

*Remove the pericardium. 

Pericardiectomy is the surgical removal of all or a portion of the pericardium. This procedure is usually reserved for treatment of recurring pericardial effusions despite catheter drainage. The heart can function adequately without the pericardium.


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Lusaka, Zambia.

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