Overview

Pericardial effusion (per-e-KAHR-dee-ul uh-FU-zhun) is the buildup of excess fluid in the sac-like structure around the heart (pericardium).

The pericardium has two layers. The space between the layers normally contains a thin layer of fluid. But if the pericardium is diseased or injured, the resulting inflammation can lead to excess fluid. Fluid can also build up around the heart without inflammation, such as from bleeding after a chest trauma.

Pericardial effusion puts pressure on the heart, affecting the heart's function. If untreated, it can lead to heart failure or death.

Symptoms

You can have significant pericardial effusion without signs or symptoms, particularly if the fluid has increased slowly.

If pericardial effusion symptoms do occur, they might 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
  • Chest fullness
  • Swelling in the legs or abdomen

When to see a doctor

Call 911 or 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.

See your doctor if you have shortness of breath.

Causes

Pericardial effusion can result from inflammation of the pericardium (pericarditis) in response to illness or injury. Pericardial effusion can also occur when the flow of pericardial fluid is blocked or when blood collects within the pericardium, such as from a chest trauma.

Sometimes the cause can't be determined (idiopathic pericarditis).

Causes of pericardial effusion include:

  • Inflammation of the pericardium following heart surgery or a heart attack
  • Autoimmune disorders such as rheumatoid arthritis or lupus
  • 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 treatments for cancer, including doxorubicin (Doxil) and cyclophosphamide
  • Waste products in the blood due to kidney failure (uremia)
  • Underactive thyroid (hypothyroidism)
  • Viral, bacterial, fungal or parasitic infections
  • Trauma or puncture wound near the heart after open-heart surgery
  • 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

Complications

Depending on how quickly pericardial effusion develops, the pericardium can stretch somewhat to accommodate the excess fluid. However, too much fluid causes the pericardium to put pressure on the heart, which prevents the chambers from filling completely.

This condition, called tamponade (tam-pon-AYD), results in poor blood flow and a lack of oxygen to the body. Tamponade is life-threatening and requires emergency care.

March 11, 2020
  1. Hoit BD. Etiology of pericardial disease. https://www.uptodate.com/contents/search. Accessed Feb. 10, 2020.
  2. Hoit BD. Diagnosis and treatment of pericardial effusion. https://www.uptodate.com/contents/search. Accessed Feb. 10, 2020.
  3. Lekhakul A, et al. Incidence and management of hemopericardium: Impact of changing trends in invasive cardiology. Mayo Clinic Proceedings. 2018;93:1086.
  4. Bonow RO, et al., eds. Pericardial diseases. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Saunders Elsevier; 2019. https://www.clinicalkey.com. Accessed Feb. 10, 2020.
  5. Mankad R (expert opinion). Mayo Clinic. Feb. 28, 2020.

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