Pericardial Effusion Clinical Presentation

Updated: Sep 25, 2016
  • Author: William J Strimel, DO, FACP; Chief Editor: Richard A Lange, MD, MBA  more...
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Presentation

History

Cardiovascular symptoms in pericardial effusion can include the following:

  • Chest pain, pressure, discomfort - Characteristically, pericardial pain may be relieved by sitting up and leaning forward and is intensified by lying supine.
  • Light-headedness, syncope
  • Palpitations

Respiratory symptoms can include the following:

  • Cough
  • Dyspnea
  • Hoarseness

Neurologic symptoms of pericardial effusion can include anxiety and confusion, while hiccoughs may occur as a gastrointestinal (GI) symptom.

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Physical Examination

Cardiovascular findings in pericardial effusion can include the following:

  • Classic Beck triad of pericardial tamponade - Hypotension, muffled heart sounds, jugular venous distention
  • Pulsus paradoxus - Exaggeration of physiologic respiratory variation in systemic blood pressure, defined as a decrease in systolic blood pressure of more than 10mm Hg with inspiration, signaling falling cardiac output during inspiration
  • Pericardial friction rub
  • Tachycardia
  • Hepatojugular reflux - This can be observed by applying pressure to the periumbilical region; a rise in the jugular venous pressure (JVP) of greater than 3 cm H 2 O for more than 30 seconds suggests elevated central venous pressure (however, transient elevation in JVP may be normal)

Pericardial friction rub, the most important physical sign of acute pericarditis, may have up to 3 components per cardiac cycle and is high-pitched, scratching, and grating. It can sometimes be elicited only when firm pressure with the diaphragm of the stethoscope is applied to the chest wall at the left lower sternal border. The pericardial friction rub is heard most frequently during expiration with the patient upright and leaning forward.

Respiratory findings can include the following:

  • Tachypnea
  • Decreased breath sounds - Secondary to pleural effusions [9]
  • Ewart sign - Dullness to percussion beneath the angle of left scapula from compression of the left lung by pericardial fluid

Hepatosplenomegaly represents a GI symptom of pericardial effusion. Findings in the patient’s extremities can include weakened peripheral pulses, edema, and cyanosis.

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