Pericardial effusion

What is pericardial effusion?

Pericardial effusion defines the presence of an abnormal amount of fluid in the pericardial space. It can be caused by local and systemic disorders, or it may be idiopathic. Pericardial effusions can be acute or chronic, and the time course for development has a great impact on the patient's symptoms. The pericardial space normally contains 15-50 ml of fluid, which serves as lubrication for the visceral and parietal layers of the pericardium. The pericardium and pericardial fluid provide important contributions to cardiac function. The normal pericardium can stretch to accommodate a small amount of fluid without significant change in intrapericardial pressure evenly distribute force across the heart, the pericardial structures assist in ensuring uniform contraction of the myocardium. Evenly distribute force across the heart.

Clinical manifestations of pericardial effusion are highly dependent upon the rate of accumulation of fluid in the pericardial sac. Rapid accumulation of pericardial fluid may cause elevated intrapericardial pressures with as little as 80 ml of fluid, while slowly progressing effusions can grow to 2l without symptoms.

Pericardial effusion - Causes

The cause of abnormal fluid production depends on the underlying causes

1) Usually secondary to injury or (i.e, pericarditis)
2) Transudative fluids result from obstruction of fluid drainage, which occurs through lymphatic channels
3) Exudative fluids occur secondary to inflammatory, infectious, malignant, or autoimmune processes within the pericardium.

• Idiopathic: In most cases, the underlying cause is not identified.
• Infectious

• HIV infection can lead to pericardial effusion through several  mechanisms, including the following:

• Secondary bacterial infection
• Opportunistic infection
• Malignancy (Kaposi sarcoma, lymphoma)
• Viral: The most common cause of infectious pericarditis and myocarditis is viral. Common, organisms include
• Pyogenic (pneumococci, streptococci, staphylococci, Neisseria, Tuberculous
• Fungal (histoplasmosis, coccidioidomycosis, Candida)
• Other infections (syphilitic, protozoal, parasitic)
• Postoperative/postprocedural     Pericardial effusions in cardiac  transplant patients are associated with an increased prevalence of acute rejection.

• Other less common causes include the following:

• Uremia(Kidney Failure)
• Myxedema(Hypo Thyroidism)
• Severe pulmonary hypertension
• Radiation therapy
• Acute myocardial infarction, including the complication of free wall rupture
• Aortic dissection, leading to hemorrhagic effusion in from leakage into pericardial sac
• Trauma
• Hypersensitivity or autoimmune related

• Systemic lupus erythematosus
• Rheumatoid arthritis
• Ankylosing spondylitis
• Rheumatic fever
• Drug-associated (eg, procainamide, hydralazine, isoniazid, minoxidil, phenytoin, anticoagulants, methysergide)

Symptoms

• Cardiovascular

• Chest pain, pressure, discomfort: Characteristically, pericardial pain may be relieved by sitting up and leaning forward and is intensified by lying supine.
• Light-headedness, syncope
• Palpitations
• Respiratory

• Cough
• Dyspnea
• Hoarseness
• Gastrointestinal

• Hiccoughs
• Neurologic

• Anxiety
• Confusion

Pericardial effusion – Signs

• Pericardial friction rub: The most important physical sign of acute pericarditis may have up to 3 components per cardiac cycle and is high-pitched, scratching, and grating. It can sometimes be elicited only when firm pressure with the diaphragm of the stethoscope is applied to the chest wall at the left lower sternal border.
• Tachycardia
• Tachypnea
• Decreased breath sounds (secondary to pleural effusions)
• Hepatosplenomegaly(enlarged liver and spleen)
• Weakened peripheral pulses
• Edema
• Cyanosis

Source: Portal Content Team