What are the clinical symptoms of pericardial effusion

The heart is an important organ of ours. Pericardial effusion is a disease caused by infection of the heart by bacteria or viruses, and it may also be a complication of other diseases. Many people may not pay attention to the early symptoms of pericardial effusion, so today we will talk about the clinical symptoms of pericardial effusion.

The clinical manifestations of pericardial effusion vary depending on the cause. Patients with small amounts of pericardial effusion may have no symptoms or mild symptoms, and the symptoms may be easily masked by the symptoms of the primary disease. Infectious patients often have systemic symptoms such as fever, sweating, fatigue, and lack of appetite. Tuberculosis often has a slow onset, with symptoms such as afternoon hot flashes, night sweats, weight loss, and weakness. The onset of purulent cases is rapid, and they often present with symptoms of poisoning such as chills, high fever, sweating, and weakness; while the systemic toxicity symptoms of non-infectious cases are milder.

In the fibrinous pericarditis (dry pericarditis) stage, there is often chest pain, which is often located in the precordial area, behind the sternum or in the swollen area of ​​the left shoulder. The pain is sharp or dull. It worsens with deep breathing, coughing, and lying on the left side, and is relieved when sitting and leaning forward. The pain of viral or "acute nonspecific pericarditis" is often severe and sometimes unbearable; on the contrary, the chest pain of uremia, lupus erythematosus, and tuberculous pericarditis is milder.

In fibrinous pericarditis, a pericardial friction sound is often heard between the 3rd and 4th intercostal spaces on the left side of the sternum. During the exudative pericarditis stage, chest pain may be alleviated or even disappear, but symptoms of compression of adjacent organs may appear, such as dyspnea, dysphagia, hoarseness, dry cough, etc. If the pericardial effusion exceeds 300ml, the cardiac dullness circle will increase and change with the change of body position, the apical beat will weaken or disappear, and the apical beat point will be on the inner side of the left edge of the cardiac dullness circle or cannot be touched. The heart sounds are distant, and sometimes early diastolic pericardial percussion sound can be heard between the 3rd and 4th intercostal spaces on the left edge of the sternum.

Pericardial effusion examination

1. X-ray examination

The cardiac shadow generally expands to both sides (effusion is more than 300 ml); when there is a large amount of effusion (greater than 1000 ml), the cardiac shadow is flask-shaped, the superior vena cava shadow is widened, and the heart beats weakly under fluoroscopy. Clear lung fields can be distinguished from heart failure.

2. Electrocardiogram

Voltage alternation is often seen in patients with low voltage, tachycardia, and large amounts of effusion.

3. Echocardiography

M-mode ultrasound reveals liquid dark areas between the anterior cardiac wall and behind the posterior cardiac wall, that is, when the diastolic dark area between the pericardium and the epicardium is the largest (if it is 10 mm, the effusion is small; if it is between 10 and 19 mm, it is moderate; if it is greater than 20 mm, it is large).

4. Pericardiocentesis

It can confirm the presence of pericardial effusion and relieve symptoms of cardiac tamponade. A portion of the effusion is collected for laboratory testing to detect possible causes.