Q. What are the Symptoms and Signs of pericardial effusion?

Asymptomatic: Slowly accumulating small to moderate pericardial effusion may not cause significant elevation of intra-pericardial pressure and hence are asymptomatic. Occasionally these patients complain of fatigue or exertional breathlessness.

Symptoms and Signs

Symptoms of large pericardial effusion are:

a) Feeling of dull ache or pressure in the centre part of chest.

b) Symptoms due to compressive effect of fluid filled pericardial sac on neighbouring structures:

i) Dyspnoea - due to lung compression and collapse. Bronchial heart sounds and impaired resonance on percussion below the angle of the left scapula due to lung collapse in large pericardial effusion is known as Ewart's sign.

ii) Dysphagia - due to oesophageal compression.

iii) Irritating cough - due to bronchial irritation and compression.

iv) Hiccough - due to phrenic nerve stretch and irritation.

v) Hoarseness - rarely can occur due to compression of left recurrent laryngial nerve.

c) Symptoms due to systemic venous congestion like facial puffiness, right hypochondrial pain, abdominal fullness and nausea can occur.

d) Massive and rapid pericardial effusion can cause cardiac tamponade which can cause haemodynamic collapse - fall in cardice output, hypotension and shock.

Clinical Signs of PE

Jugular venous pressure may be elevated in moderate PE. ‘X' descent will be more prominent than ‘Y' descent. No abnormal impulses over the precordium. On percussion, the dull note may extend beyond the palpated apex beat and also on to the right side of sternum. Heart sounds may be feeble and pericardial rub may be heard. Investigations 1) Electrocardiogram (ECG): Low voltage complexes is the classical ECG finding. In massive PE with tamponade, electrical alternans, (sometimes total electrical alternans) can occur.

2) X-ray Chest: Uniform cardiomegaly with a smooth outline is characteristic of PE. The superior venacava is usually engorged. Pulmonary vessels will be less prominent. In large pericardial effusion, the cardio-phrenic angle will be acute.