Pericardial effusion


Accumulation of excess fluid in the pericardial sac is called pericardial effusion. The normal pericardial sac contains about 50 ml of fluid).

Causes: According to the character of fluid-

  • Purulent/suppurative: Pygenic bacterial and viral causes.
  • Serous: CCF, hypoprotenaemia, cirrhosis of liver Myxoedema/Nephrotic syndrome.
  • Haemorrhage: Malignancy, Tuberculous, Traumatic (rarely)

Types: It may be:

  • transudative (congestive heart failure,myxoedema, nephrotic syndrome)
  • exudative (tuberculosis, spread from empyema )
  • haemorrhagic (trauma, rupture of aneurysms, malignant effusion).
  • malignant (due to fluid accumulation caused by


Clinical features:


  1. Central chest pain (initially):
  • Pain increased in leaning forward.
  • Disappears when pericardial effusion develops.
  1. Further symptoms develops on the amount of fluid and rapidity of collection of fluid-
  • Heaving of chest.
  • Dyspnoea on exertion.
  • Orthopenia
  1. Features of the cause.


  1. Pulse: Pulse paradoxus, low volume tachycaadia.
  2. BP: Usually low.
  3. JVP: Raised with sharp descend of ‘y’ wave.
  4. Dependent oedema (present if constrictive pericarditis)
  5. Precordium:
  • Apex beat-Not palpable.
  • Percussion note: Area of cardiac dullness increased.
  • Auscultation-Heart sounds are feeble.
  • Signs of underlying cause.
  1. Pericardial friction rub may present in early cases without temponade.


  1. Blood for TC, DC, ESR, Hb%.
  2. X-ray chest P/A view (serial radiography may show)
  • Rapid increased in the size of cardiac shadow.
  • Heart is globular or pear shaped (in large effusion)
  1. ECG: Low voltage.
  2. Fluoroscopy: Non pulsatile enlarged cardiac shadow.
  3. Paracentasis of pericardial fluid.


  1. Symptomatic treatment: Rest, diuretics, analgesic.
  2. Pericardial effusion without temponade: No specific treatment.
  3. Pericardial effusion with temponade: Paracentasis (the fluid is aspirated by introducing a needle just medial to the cardiac apex or by inserting a needle below the xiphoid process and directed towards the left shoulderly.
  4. Surgical drainage: If viscous, loculated or recurrent effusion.


  1. Davidson’s Principles and Practice of Medicine, 21st
  2. Kumar and clark Medicine, 7th
  3. Wikipedia free encyclopedia.

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