Pericardial effusion

Description

Pericardial effusion (by e-KAHR-dee-ul uh-FU-zhun) is the excessive accumulation of fluid in the double layer, saclike structure around the heart (pericardium).

The space between these layers usually contain a thin layer of fluid. But if the pericardium is diseased or injured, the result of the inflammation can lead to excess fluid. The fluid can also accumulate around the heart without inflammation, such as bleeding, related to a cancer or after a chest trauma.

Pericardial effusion can put pressure on the heart, which affect how the heart works. If not treated, it can lead to heart failure or death in extreme cases.

Symptoms

Pericardial effusion may not cause any noticeable signs and symptoms, especially if the fluid has increased slowly.

If the pericardial effusion with signs and symptoms, which may include:

  • Shortness of breath or difficulty breathing (dyspnea)
  • Discomfort when breathing while lying down
  • Pain in the chest, usually behind the breastbone or in the left side of the chest
  • Chest fullness
  • Dizziness or feeling faint
  • Swelling in the abdomen or in the legs

When to see a doctor

Call 911 or the local emergency number if you feel pain in the chest that lasts more than a couple of minutes, if breathing is difficult or painful, or if you have an unexplained episode of fainting.

Consult your health care provider if you have shortness of breath.

Causes

Pericardial effusion may be the result of inflammation of the pericardium (pericarditis) after an illness or injury. In some environments, large spills can be caused by certain types of cancer. A lock of pericardial fluids or a collection of blood in the pericardium can also lead to this condition.

Sometimes, the cause can not be determined (pericarditis idiopathic).

Causes of pericardial effusion may include:

  • Autoimmune disorders, such as rheumatoid arthritis or lupus
  • Cancer of the heart or pericardium
  • The spread of cancer (metastasis), particularly lung cancer, breast cancer or Hodgkin's lymphoma
  • Radiation therapy for cancer if the heart was in the area of the radiation
  • Chest trauma
  • Inflammation of the pericardium after a heart attack or after a heart surgery or a procedure in where the heart of the lining is injured
  • Low activity of the thyroid gland (hypothyroidism)
  • Use of certain medications, or exposure to toxins
  • Viral, bacterial, fungal, or parasitic
  • The waste products in the blood due to kidney failure (uremia)

Complications

A potential complication of pericardial effusion is cardiac tamponade (tam-pon-AYD). In this condition, the excess of fluid in the pericardium puts pressure on the heart. The tension prevents the chambers of the heart to fill completely with blood.

Cardiac tamponade results in poor blood flow and a lack of oxygen in the body. Cardiac tamponade is life-threatening and requires emergency medical treatment.

Pericardial effusion

Diagnosis

To diagnose pericardial effusion, the health care provider will typically perform a physical exam and ask you questions about your symptoms and medical history. He or she is likely to listen to your heart with a stethoscope. If your doctor thinks you may have pericardial effusion, the tests can help identify a cause.

Tests

The tests to diagnose or confirm pericardial effusion may include:

  • The echocardiogram. Use sound waves to create images of the heart in motion. An echocardiogram shows the heart chambers and how well the heart is pumping the blood. The test can help determine the amount of fluid between the two layers of the pericardium. An echocardiogram may also show decreased function of the heart due to the pressure on the heart (tamponade).
  • Electrocardiogram (ECG or EKG). This quick and painless test that measures the electrical activity of the heart. Sticky patches (electrodes) are placed on the chest and sometimes the arms and legs. The wires connect the electrodes to a computer, which displays the results of the test. Your cardiologist or other health care provider, you can search for patterns of signals that suggest that cardiac tamponade.
  • X-ray of the chest. An X-ray image of the chest allows a health care provider to check the size and shape of the heart. A chest x-ray may show signs of enlargement of the heart if the spill is large.

computed tomography (CT) and Magnetic resonance imaging (MRI) can detect pericardial effusion, although it is generally not used to find the condition. However, the pericardial effusion can be diagnosed when these tests are done for other reasons.

Treatment

Treatment of pericardial effusion depends on:

  • The amount of the fluid accumulation
  • The cause of pericardial effusion
  • The presence or risk of tamponade cardiac

Drugs

If you do not have cardiac tamponade, or there is no immediate threat of cardiac tamponade, your health care provider may prescribe one of the following medications to treat inflammation of the pericardium:

  • Aspirin
  • Nonsteroidal anti-inflammatory drugs (Nsaids) such as ibuprofen (Advil, Motrin IB, others)
  • Colchicine (Colcrys, Mitigare)
  • A corticosteroid, such as prednisone

Surgery or other procedures

Your health care provider may recommend procedures for drainage of a pericardial effusion or prevent the future accumulation of liquid if:

  • The drugs do not correct the pericardial effusion
  • A large spill is causing the symptoms and increase the risk of tamponade cardiac
  • You have cardiac tamponade

Drainage procedures or surgery to treat pericardial effusion may include:

  • Drainage of fluid (pericardiocentesis). A doctor uses a needle to enter in the space, pericardial, and then inserts a small tube (catheter) to drain the fluid. Imaging techniques, usually echocardiography, are used to guide the work. Generally, the catheter is left in place to drain the pericardial space for a couple of days to help prevent the future accumulation of fluid. The catheter is removed when all the fluid has drained out, and it does not re-accumulate.
  • Open-heart surgery. If there is bleeding into the pericardium, especially due to the recent heart surgery or other complicating factors, open-heart surgery may be done to drain the pericardium and repair any damage. Sometimes, a surgeon can create a hallway that allows the fluid to drain as needed within the abdominal cavity, where it can be absorbed.
  • The removal of the pericardium (pericardiectomy). If pericardial, continue to occur despite of the drainage procedures, a surgeon may recommend removal of all or part of the pericardium.

Preparing for your appointment

If the pericardial effusion is discovered as a result of a heart attack or another emergency, you will not have time to prepare for your appointment. Otherwise, you will likely start by seeing your primary care provider. You may be referred to a doctor who specializes in heart conditions (cardiologist).

What you can do

When you make the appointment, ask if there is something that you need to do in advance, such as fasting before a specific test. Make a list of:

  • Your symptoms, including any that seem unrelated to your heart or breathing
  • Key personal information, including major stresses, recent changes in the life and medical history
  • All medications, vitamins or supplements you are taking, including dose
  • Questions to ask your health care provider

Have a friend or family member, if possible, to help you remember the information that you receive.

Pericardial effusion, some basic questions to ask your doctor include:

  • What is likely causing my symptoms?
  • What tests do I need?
  • You should see a specialist?
  • How serious is my condition?
  • What is the best course of action?
  • I have other health conditions. How can I best manage these conditions?
  • Are there brochures or other printed material I can have? What sites do you recommend?

What to expect from your doctor

Your health care provider is likely to ask a series of questions, including:

  • When did symptoms begin?
  • Do you always have symptoms, or the symptoms come and go?
  • What, if anything, seems to improve your symptoms? For example, your chest pain is less severe when sitting and leaning forward?
  • What, if anything, appears to worsen your symptoms? For example, are your symptoms get worse when you are active or lying down?
Symptoms and treatment of Pericardial effusion