Definition:

Pericardial effusion is usually secondary to insult/injury to the pericardium.  The inflammation in the pericardium secondary to noxious stimuli causes an accumulation of fluid (exudate/transudate) into the pericardial space, either in an acute setting or chronic nature.  Causes include: infection, uremia, cancer, myocardial infarction, trauma, rheumatic fever, Whipple disease, and sarcoidosis.

Symptoms:

• Chest pain/pressure/discomfort that is relieved by sitting up or leaning forward and worsened by lying flat
• Light-headedness
• Syncope
• Palpitations
• Cough, dyspnea (shortness of breath)
• Anxiety
• Confusion

Diagnosis:

• Physical Exam
  • Hypotension, muffled heart sounds, elevated jugular vein pulse
  • Pulsus paradoxus - decrease in systolic blood pressure >10mmHg with inspiration
  • Pericardial friction rub heard with stethoscope
  • Widened pulse pressure
• Electrocardiography - low voltage signal throughout
• Chest X-Ray - "water bottle" appearance of heart (enlarged)
• Echocardiography - echo-free space between layers of pericardium diagnostic
• Pericardiocentesis - must be done, sent for infections, tumor cells, etc
• CT/MRI - imaging of chest to see fluid around heart

Treatment:

• Depends on cause, can use aspirin/NSAIDS, steroids, antibiotics, etc
• Surgery
  • Subxiphoid pericardial window with pericardiostomy
  • Thoracotomy - if conservative approach has failed
  • Video-assisted thoracic surgery - able to see wider area of pericardium and pleural region
  • Median sternotomy - for constrictive pericarditis