Pericardial Effusion is a condition in which there is an abnormal accumulation of fluid in the sac surrounding the heart. It occurs as a result of inflammation of the pericardium from illness or injury. This causes an abnormal amount of fluid to build up in the layer between the pericardium, which can press on and interfere with the functioning of the heart. If left untreated, it can lead to heart failure or death.
The pericardium is a strong, tough and flexible sac divided into two layers. Between the layers is a clear yellow fluid of approximately 15-30 milliliters. It helps to wrap around the heart to protect it from injury or damage and to reduce friction between the pericardium while the heart is working.
Symptoms of Pericardial Effusion
Patients usually do not show any symptoms if the amount of fluid accumulated in the pericardium is not much or there is no inflammation. However, symptoms may occur when the pericardium enlarges and fluid accumulates for a long time, causing the pericardial sac to press on nearby areas such as the lungs, abdomen, nerves connected to the diaphragm (Phrenic Nerve), or it may be caused by diastolic heart failure from being compressed by the pericardium. Symptoms that patients may experience include:
- Chest pain or tightness is the main symptom, usually occurring behind the breastbone or on the left side of the chest.
- Shortness of breath, difficulty breathing, discomfort when breathing while lying down
- Fatigue, dizziness, cold hands and feet and sweating
- Muscle pain
- Nausea, vomiting, or diarrhea may occur in cases of viral infection.
- Feeling full in the stomach
- Difficulty swallowing
- Heart beats fast
Patients should seek immediate medical attention if they experience chest pain lasting several minutes, have difficulty breathing, feel pain while breathing, or feel faint without a known cause. However, if they experience a bluish discoloration of the skin or lips, develop shock, or experience decreased consciousness, they should seek immediate medical attention as these could be signs of cardiac tamponade, which is an emergency and can be life-threatening if not treated promptly.
Causes of Pericardial Effusion
Most often, Pericardial Effusion is caused by inflammation of the pericardium caused by other diseases, injury, drainage of fluid in the pericardium, obstruction or blood buildup in the pericardium after a trauma. Causes that may lead to Pericardial Effusion include:
- Pericarditis from cardiac surgery or myocardial ischemia
- Cancers such as heart cancer, pericardial cancer, and metastases, especially from lung cancer, breast cancer, melanoma, leukemia, and Hodgkin lymphoma .
- Immune system disorders, such as rheumatoid arthritis or lupus
- Hypothyroidism
- Uremia
- Viral, bacterial, fungal or parasitic infection
- Injury or stab wound near the heart
- Cancer treatment includes radiation therapy that extends to the heart, or chemotherapy, such as doxorubicin and cyclophosphamide.
- Taking certain medications, including the blood pressure-lowering drug hydralazine, the tuberculosis drug isoniazid, and the epilepsy drug phenytoin.
However, in some cases, it can occur without a known cause (Idiopathic Pericardial Effusions). If you suspect that there is an abnormality, you should see a doctor to diagnose the possible cause.
Diagnosis of Pericardial Effusion
Since early pericardial effusion is often asymptomatic, diagnosis often reveals abnormalities from other physical examinations. In general, the doctor will ask about symptoms, perform a basic physical examination, and perform additional tests using the following methods:
- An electrocardiogram (ECG/EKG) is a test that records the electrical activity of the heart during each heartbeat through a transducer attached to the skin to detect pericardial effusion, cardiac tamponade, or other inflammation that may occur.
- Anechocardiogram uses high-frequency sound waves to help doctors diagnose Pericardial Effusion , which is the space between the layers of the pericardium, and show possible deterioration in heart function, such as damage to the heart chambers or a decrease in the heart’s ability to pump blood due to cardiac tamponade.
- A chest X-ray allows the doctor to examine the fluid in the pericardium through a clearer image of the X-ray film.
- Computed tomography (CT) scan and magnetic resonance imaging (MRI) scan, although not commonly used to diagnose pericardial effusion, may be used in some cases.
- Other diagnostic tests, such as blood tests or pericardial fluid sampling, are available for diagnosis.
Pericardial Effusion Treatment
Treatment for pericardial effusion varies depending on the severity of the symptoms. Your doctor will consider the amount of fluid that has accumulated in your pericardium or the risk of developing a concomitant cardiac tamponade.
Drug treatment
If a patient does not have symptoms of angina, the doctor may prescribe medications to treat inflammation of the pericardium that may later lead to pericardial effusion, such as:
- Aspirin
- NSAIDs ,such as ibuprofen, naproxane, and indomethacin.
- Colchicine
- Corticosteroids, such as prednisone and methylprednisolone.
- Antibiotics are used if the patient has an infection.
- Diuretics and other heart failure medications may be used if a person has symptoms of heart failure.
If the pericardial effusion is caused by a pre-existing cancer, treatment will include chemotherapy, radiation, and medications to treat cancer in the chest area.
Medical treatment
If medication does not improve symptoms, there is a large amount of fluid accumulated in the pericardium that may be at risk of cardiac tamponade, or there are already symptoms of cardiac tamponade, the doctor will drain the remaining fluid and prevent the pericardial tamponade from recurring later in the following way:
- Pericardiocentesis
The doctor will use a needle and insert a catheter to drain the fluid inside the pericardium. The catheter is usually left in place for 2-3 days to prevent the fluid from building up again in the pericardium.
In addition, doctors may use assistive devices such as an echocardiography machine, an X-ray called fluoroscopy to obtain images of the internal organs at that time, or an electrocardiogram (EKG /ECG ) machine that will help provide images of the heart during surgery.
- Open heart surgery
If a person has bleeding into their pericardium, especially after heart surgery or other complications, their doctor may perform surgery to drain the blood from the pericardium and repair the damage. In some cases, a bypass may be performed to drain the fluid into the abdomen, where it can be absorbed.
- Balloon Pericardiotomy
The doctor will insert a tube with a balloon at the end that helps to expand and open up a hole to allow the fluid between the layers of the pericardium to drain out. However, this method is not commonly used for treatment.
- Surgical removal of some or all of the pericardium
This method is used if the patient’s symptoms recur despite treatment with a drainage catheter.
Complications of Pericardial Effusion
Complications of pericardial effusion vary depending on how quickly the symptoms develop. Although the pericardium can expand to accommodate excess fluid, excessive fluid buildup can cause pressure on the heart, which can reduce blood flow to the heart and lead to insufficient oxygen supply to the body. Pericardial effusion can cause a drop in blood pressure and may lead to shock , which can be life- threatening . It is therefore an emergency that requires prompt treatment.
Prevention of Pericardial Effusion
Maintaining overall good health may help reduce the risk of Pericardial Effusion, such as exercising regularly, eating a healthy diet, and having regular health check-ups. For those with chronic diseases, they should follow their doctor’s advice and follow up with their treatment regularly. If there are any abnormalities, they should see a doctor.
