Pericardial effusion

Chest pain or pressure are common symptoms. A small effusion may be asymptomatic. Larger effusions may cause cardiac tamponade, a life-threatening complication; signs of impending tamponade include dyspnea, low blood pressure, and distant heart sounds.

The so-called "water-bottle heart" is a radiographic sign of pericardial effusion, in which the cardiopericardial silhouette is enlarged and assumes the shape of a flask or water bottle.

It can be associated with dullness to percussion over the left subscapular area due to compression of the left lung base. This phenomenon is known as Ewart's sign.[1]

• Pericarditis
• Long term usage of cabergoline ingredient (dopamine agonists)
• Viral infection (coxsackie virus)
• Infection including tuberculosis
• Drug eluting stents
• Inflammatory disorders, such as lupus, rheumatoid arthritis[2] and post myocardial infarction pericarditis (Dressler's syndrome)
• Cancer that has spread to the pericardium
• Trichinosis
• Kidney failure with excessive blood levels of urea nitrogen
• Minoxidil
• Hypothyroidism
• Heart surgery[3] (Postpericardiotomy syndrome)

Massive pericardial effusion

Sinus tachycardia with low QRS voltage and QRS alternans

It may be:

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

The most common causes of pericardial effusion have changed over time and vary depending on geography and the population in question. When pericardial effusion is suspected, echocardiography usually confirms the diagnosis and allows assessment for signs of hemodynamic instability. Cross-sectional imaging with computed tomography (CT) can help to localize and quantify (as in a loculated effusion) or assess for pericardial pathology (pericardial thickening, constrictive pericarditis).[4]

• 
  A CT scan image showing a pericardial effusion
• 
  A very large hemorrhagic pericardial effusion due to malignancy as seen on ultrasound. closed arrow: the heart, open arrow: the effusion
• 
  Pericardial effusion due to malignancy. Note bulbous heart and primary lung cancer in right upper lobe.
• 
  An ECG showing electrical alternans in a person with a pericardial effusion.
• 
  A pericardial effusion due to pericarditis
• Loculated pericardial effusion[5]

Treatment depends on the underlying cause and the severity of the heart impairment. Pericardial effusion due to a viral infection usually goes away within a few weeks without the treatment. Some pericardial effusions remain small and never need treatment. If the pericardial effusion is due to a condition such as lupus, treatment with anti-inflammatory medications may help. If the effusion is compromising heart function and causing cardiac tamponade, it will need to be drained, most commonly by a needle inserted through the chest wall and into the pericardial space called pericardiocentesis. A drainage tube is often left in place for several days. In some cases, surgical drainage may be required by cutting through the pericardium creating a pericardial window.

• Pericardial Disease Cleveland Clinic Online Medical Reference

Heart glows when a Cook needle enters the pericardium