Pericardial Effusion

ExitCare ImagePericardial effusion is an accumulation of extra fluid in the pericardial space. This is the space between the heart and the sac that surrounds it. This space normally contains a small amount of fluid which serves as lubrication for the heart inside the sac. If the amount of fluid increases, it causes problems for the working of the heart. This is called a heart (cardiac) tamponade.


A higher incidence of pericardial effusion is associated with certain diseases. Some common causes of pericardial effusion are:

  • Infections (bacterial, viral, fungal, from AIDS, etc.).

  • Cancer which has spread to the pericardial sac.

  • Fluid accumulation in the sac after a heart attack or open heart surgery.

  • Injury (a fall with chest injury or as a result of a knife or gunshot wound) with bleeding into the pericardial sac.

  • Immune diseases (such as Rheumatoid Arthritis) and other arthritis conditions.

  • Reactions (uncommon) to medications.


Very small effusions may cause no problems. Even a small effusion if it comes on rapidly can be deadly.

Some common symptoms are:

  • Chest pain, pressure, discomfort.

  • Light-headed feeling, fainting.

  • Cough, shortness of breath.

  • Feeling of palpitations.

  • Hiccoughs

  • Anxiety or confusion


Your caregiver may do a number of blood tests and imaging tests (like X-rays) to help find the cause.

  • ECHO (Echocardiographic stress test) has become the diagnostic method of choice. This is due to its portability and availability. CT and MRI are also used, and may be more accurate.

  • Pericardioscopy, where available, uses a telescope-like instrument to look inside the pericardial sac.

  • This may be helpful in cases of unexplained pericardial effusions. It allows your caregiver to look at the pericardium and do pericardial biopsies if something abnormal is found.

  • Sometimes fluid may be removed to help with diagnosing the cause of the accumulation. This is called a pericardiocentesis.


Treatment is directed at removal of the extra pericardial fluid and treating the cause. Small amounts of effusion that are not causing problems can simply be watched. If the fluid is accumulating rapidly and resulting in cardiac tamponade, this can be life-threatening. Emergency removal of fluid must be done.


  • You develop chest pain, irregular heart beat (palpitations) or racing heart, shortness of breath, or begin sweating.

  • You become lightheaded or pass out.

  • You develop increasing swelling of the legs.