The pericardium is the sac surrounding the heart, and typically contains about 10-15 ml of clear fluid only. In some circumstances, fluid may accumulate in this sac, leading to potentially serious consequences – breathlessness, dizziness, blackouts, and even collapse and death. Mild accumulation does not cause significant problems; in this case, waiting for resolution of the fluid accumulation is all that is necessary.

Echo showing pericardial effusion – more noticeable from 3 – 5 o’clock position

Fluid can accumulate due to a variety of reasons:

  • Infection – bacterial or viral infections
  • Heart attack
  • Recent open heart surgery (most common cause)
  • Trauma
  • Cancer
  • Idiopathic

Significant accumulation of fluid around the pericardium can result in impairment of heart pumping ability – a condition called pericardial tamponade. This is a cardiac emergency, and requires urgent drainage of the fluid in a procedure called pericardiocentesis (pericardial aspiration).

Pericardiocentesis is the term used to describe the insertion of a needle into the sac surrounding the heart to remove fluid causing compression of the heart.

CXR showing enlarged heart shadow (right)

Two approaches to pericardiocentesis

Video of cardiac tamponade: