Signs and Symptoms of Pericardial Effusion

Pericardial effusion, the accumulation of excess fluid around the heart, can present with a variety of clinical signs depending on the severity and speed of fluid buildup. Recognizing these symptoms is crucial for early diagnosis and treatment.

Mild Pericardial Effusion

In cases of mild or small-volume pericardial effusion, patients may not exhibit any noticeable physical signs. However, some individuals might experience mild chest discomfort or sharp, pleuritic-type chest pain that worsens with deep breathing or lying down. During a physical examination, a healthcare provider may detect a characteristic sound known as a pericardial friction rub when listening to the heart with a stethoscope.

Large or Significant Pericardial Effusion

When the effusion becomes more substantial, symptoms tend to become more pronounced. Patients may develop shortness of breath, especially when lying flat, often leading to orthopnea—difficulty breathing unless sitting upright. Tachycardia, or an abnormally fast heart rate, is commonly observed. In more severe cases, a physical exam might reveal pulsus paradoxus, an exaggerated drop in blood pressure during inspiration.

Physical Examination Findings

Visual inspection may show a bulging appearance in the chest area, particularly over the heart region. The point of maximal impulse (PMI) may be displaced downward and to the left. Palpation can reveal a pericardial friction rub or an abnormal cardiac impulse outside the left midclavicular line. On percussion, the cardiac dullness border appears enlarged. Auscultation typically reveals muffled or distant heart sounds, and in some cases, a pericardial friction rub may still be heard.

Systemic Effects

As the condition progresses, the impaired diastolic function of the heart can lead to fluid accumulation in other body cavities, such as pleural effusion (fluid around the lungs) or ascites (fluid in the abdominal cavity), which may cause bloating or shifting dullness upon examination. Peripheral edema—particularly in the lower extremities, face, and limbs—can also develop, signaling widespread organ involvement.