What is the mechanism of pericardial effusion formation in heart failure?

Pericardial space contains 15-35 ml of fluid under physiologic conditions (1). Pericardial formation is dependent on the ultrafiltration of plasma across epidcardial and parietal pericardial capillaries a well as interstitial fluid traversing the epicardium, and is removed by the lymphatic system (1). The prevalence of pericardial fluid in congestive heart failure is 12-20%.

Experimental animal data and observations from human studies suggest that pericardial effusion in heart failure only occurs in the setting of high right-sided filling pressures. In a retrospective study of patients with primarily left ventricular dysfunction with or without pericardial effusion, enlarged right ventricular diastolic internal dimension on echocardiography was strongly correlated with the presence of pericardial effusion while systolic and diastolic internal dimensions were not (2).  Thus in patients with heart failure and pericardial effusion, high right-sided filling pressures should be suspected.

 

References

  1. Natanzon A, Kronzon I. Pericardial and pleural effusions in congestive heart failure—anatomical, pathophysiologic, and clinical considerations. Am J Med Sci 2009;338:211-216.
  2. Kessler KM, Rodriguez D, Rahim A, et al. Echocardiographic observations regarding pericardial effusions associated with cardiac disease. Chest 1980;78:736-40.
What is the mechanism of pericardial effusion formation in heart failure?

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