Pericarditis is inflammation of the sac around the heart, called the pericardium. If pericarditis becomes chronic, it can lead to pericardial effusion. This is when the pericardium fills with fluid.

The pericardium consists of two layers of tissue. A small amount of fluid separates these layers.

If the pericardium becomes inflamed, fluid can build as a complication. If too much fluid fills the pericardium, it can severely affect how much blood the heart pumps.

Pericardial effusion and pericarditis are related conditions, but they are not the same.

This article explores their causes, symptoms, diagnosis, and treatment. It also answers some common questions about the conditions.

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Pericarditis and pericardial effusion have different causes, even though they can relate to one another.

Causes of pericarditis

The underlying cause of acute pericarditis is often unclear. However, in many cases, it occurs due to viral infections. These infections may include some respiratory and digestive system infections.

Pericarditis may also develop due to:

People with autoimmune conditions, including lupus, rheumatoid arthritis, and scleroderma, may develop chronic or recurring pericarditis.

Males between 16 and 65 years old have the highest risk of pericarditis, although anyone can develop it.

Causes of pericardial effusion

Pericardial effusion occurs when fluid builds in the pericardial space.

Pericarditis due to a viral infection is the most common cause of pericardial effusion in higher income countries. Tuberculosis is a leading cause of pericardial effusion in lower income countries.

However, pericardial effusion can develop without inflammation, such as if a person has cancerous tumors. It can also result from bleeding due to blunt force trauma, penetrating trauma, or if the wall of the heart ruptures during a heart attack.

Pericarditis and pericardial effusion cause similar symptoms that include chest pain with specific qualities:

  • The pain may feel like sharpness, stabbing, dullness, or aching.
  • The pain gets worse when lying down and breathing deeply.
  • It feels better when a person sits up and leans forward.
  • It may feel like a heart attack.

Other symptoms may include:

If pericarditis becomes chronic — defined as lasting 3 months or longer — it may also cause swelling in the feet, ankles, legs, and abdomen. Chronic pericarditis may also cause low blood pressure.

Pericardial effusion may lead to a complication called cardiac tamponade. This means the fluid buildup in the pericardium has put too much pressure on the heart and it can no longer effectively fill with blood.

Cardiac tamponade causes a severe drop in blood pressure. It can be fatal without treatment.

A person should call 911 if they experience chest pain or other symptoms that may be due to a heart attack.

Is it a heart attack?

Heart attacks occur when there is a lack of blood supply to the heart. Symptoms include:

  • chest pain, pressure, or tightness
  • pain that may spread to arms, neck, jaw, or back
  • nausea and vomiting
  • sweaty or clammy skin
  • heartburn or indigestion
  • shortness of breath
  • coughing or wheezing
  • lightheadedness or dizziness
  • anxiety that can feel similar to a panic attack

If someone has these symptoms:

  1. Dial 911 or the number of the nearest emergency department.
  2. Stay with them until the emergency services arrive.

If a person stops breathing before emergency services arrive, perform manual chest compressions:

  1. Lock fingers together and place the base of hands in the center of the chest.
  2. Position shoulders over hands and lock elbows.
  3. Press hard and fast, at a rate of 100–120 compressions per minute, to a depth of 2 inches.
  4. Continue these movements until the person starts to breathe or move.
  5. If needed, swap over with someone else without pausing compressions.

Use an automatic external defibrillator (AED) available in many public places:

  1. An AED provides a shock that may restart the heart.
  2. Follow the instructions on the defibrillator or listen to the guided instructions.
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People who have chest pain or other symptoms listed above should call 911 so doctors can rule out the possibility of a heart attack.

Various healthcare professionals, such as primary care physicians, cardiologists, and infectious disease specialists, may play a role in confirming a pericarditis or pericardial effusion diagnosis and treating the condition.

For people with chest pain, a doctor may check how the pain feels when lying down and sitting up. They may also ask where it occurs on the chest and how it feels.

A doctor will also listen for the pericardial rub using a stethoscope. The pericardial rub refers to the sound of the increased levels of fluid causing the pericardium to rub against the heart’s outer layer.

A doctor may be able to identify other sounds that point to increased fluid in the pericardium.

Several scans may help a doctor confirm a diagnosis of pericarditis and pericardial effusion, including:

  • Echocardiogram: This creates images of the heart using sound waves. An echocardiogram can show the organ’s size, shape, and function, and excess fluid in the pericardium.
  • Electrocardiogram (EKG): This shows electrical activity in the heart. Some EKG results can point to pericarditis.
  • Cardiac CT scan: This builds a detailed image of the heart. It helps doctors rule out other causes of chest pain.
  • Cardiac MRI scan: This imaging scan show changes in the pericardium using an image formed from radio waves and magnets.
  • Chest X-ray: This produces images of the heart, lungs, and blood vessels. People with pericardial effusion may show an enlarged heart on a chest X-ray.
  • Blood tests: A healthcare professional may draw blood and send it to a laboratory to look for inflammatory markers that indicate pericarditis.

A doctor may also ask about recent illnesses or cancers to rule out noninfectious causes of pericardial effusion.

Pericarditis and pericardial effusion have different treatments.

Pericarditis treatment

Treatment for pericarditis involves treating the underlying infection or cause while managing pain and inflammation. Medications that doctors may prescribe include:

Pericardial effusion treatment

Doctors often monitor symptoms with a follow-up echocardiogram if they diagnose a small effusion that is not causing any symptoms.

However, if an effusion is causing symptoms or changes in vital signs, the doctor may drain the fluid from the pericardium with a needle. This procedure is called pericardiocentesis.

People experiencing pericardial effusions that have developed into cardiac tamponade may require emergency surgery and a hospital stay.

For people who develop recurrent effusions due to causes such as cancer, a pericardial window may be necessary.

During this procedure, a healthcare professional creates a hole between the pericardial space and the pleural space, which is the space around the lungs. This allows the fluid to move freely and not cause problems with the heart.

Below are some of the most common questions and answers about pericarditis and pericardial effusion.

Is pericardial effusion the same as pericarditis?

Pericarditis is inflammation of the pericardium. Pericardial effusion refers to fluid buildup within the pericardium.

Pericardial effusion is a common complication of pericarditis. However, pericarditis does not always lead to pericardial effusion, and pericardial effusion does not always occur due to pericarditis.

Is pericardial effusion a symptom of pericarditis?

Pericardial effusion can be a symptom of pericarditis. However, it may also occur independently of pericarditis due to cancer, for example.

What is the main cause of pericardial effusion?

Pericarditis due to a virus is the most common cause of pericardial effusion.

Pericarditis refers to inflammation in the pericardium, which surrounds the heart. It can lead to fluid buildup between the layers of the pericardium. Doctors refer to this as pericardial effusion.

However, pericarditis does not always result in pericardial effusion. Similarly, pericardial effusion does not always occur as a result of pericarditis.

The conditions cause similar symptoms, including chest pain that may feel similar to a heart attack. People experiencing chest pain or other symptoms, like shortness of breath, should call 911 immediately.

Healthcare professionals can then work out the underlying cause of a person’s symptoms and treat them accordingly.