Overview of pericardial effusion
Pericardial effusion is excess fluid between the heart and the sac surrounding the heart, known as the pericardium. Most are not harmful, but they sometimes can make the heart work poorly.
The pericardium is a tough and layered sac. When your heart beats, it slides easily within it. Normally, 2 to 3 tablespoons of clear, yellow pericardial fluid are between the sac’s two layers. That fluid helps your heart move easier within the sac.
The pericardium has two layers. The space between the layers usually consists of a thin layer. If the pericardium is diseased or injured, the resulting inflammation can lead to excess fluid. Fluid also builds up around the heart without inflammation, such as bleeding after a chest injury.
Pericardial effusion puts pressure on the heart and affects heart function. If left untreated, it can lead to heart failure or death.
How does excess fluid develop around the heart?
There is usually a small amount of fluid around the heart (small pericardial effusion). It is caused by shock around the heart and is an important part of normal heart function. The excess fluid around the heart is called a pericardial effusion. But where does this extra liquid come from? Oftentimes when the heart experiences inflammation (called pericarditis), excess fluid is released and accumulates within the shock. Blood shock is also possible during or after an injury, surgery, or other heart procedure problem.
The blood that surrounds the heart is called the hemopericardium. The fluid around the heart is usually produced and drained constantly, so the level is constant. Sometimes in patients with heart failure, high pressure within the heart prevents fluid from flowing properly. However, the body continues to produce pericardial fluid, which leads to excess fluid around the heart.
Symptoms of pericardial effusion
When inflammation of the sac causes a pericardial effusion, the main symptom is chest pain. It may get worse when you breathe deeply and better when you lean forward.
Other symptoms may include:
- Muscle aches
- Shortness of breath
- Nausea, vomiting, and diarrhoea (if you have a virus).
When there’s no inflammation of the sac, there are often no symptoms.
Causes of pericardial effusion
Pericardial effusion is caused by inflammation of the pericardium (pericarditis) in response to illness or injury. Pericardial effusion also occurs when the flow of pericardial fluid is blocked or when blood accumulates in the pericardium, as in a chest injury. Sometimes the cause cannot be determined.
In most cases, inflammation of the sac, a condition called pericarditis, leads to effusion. As it becomes inflamed, more fluid is produced.
Viral infections are one of the main causes of inflammation and the effusions it leads to. These infections include:
- HIV infection
In these cases, treating the underlying medical condition will often help treat the effusion.
Who is affected by pericardial effusions?
Pericardial effusions are the result of many different diseases or conditions, anyone who develops one of the many conditions that can lead to effusions can be affected. Pericardial effusions can be serious (happen quickly) or chronic (lasts more than 3 months).
Diagnosis of pericardial effusions
Your doctor will perform a physical exam, and listen to your heart with a stethoscope. If you have signs or symptoms of pericardial effusion, a series of blood and imaging tests will be done to confirm the diagnosis, identify possible causes and determine treatment. Sometimes, pericardial effusion is discovered when tests are done for other reasons.
An echocardiogram uses sound waves to create real-time images of your heart. This test allows your doctor to see how much fluid has accumulated in the space between the two layers of the pericardium. The echocardiogram also shows how well your heart is pumping blood and diagnostic tamponade or shock in one of the heart’s chambers.
There are two types of echocardiograms:
- Transthoracic echocardiogram. This test uses a sound-emitting device (transducer) that is placed on the chest and the heart.
- Transesophageal echocardiogram. A small transducer is placed in a tube in your digestive system that goes from your throat to your stomach (esophagus). Because the esophagus is so close to the heart, placing the transducer there provides a more detailed image of the heart.
If you have too much fluid in the pericardium, a chest X-ray will show an enlarged heart.
Treatment for pericardial effusion will depend on the amount of fluid, the underlying cause, and whether you have or are likely to develop cardiac tamponade. Treating the cause of pericardial effusion often corrects the problem.
Medications that reduce inflammation
If you don’t have tamponade or there’s no immediate threat of tamponade, your doctor might prescribe an anti-inflammatory drug to reduce inflammation of the pericardium:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin (Indocin) or ibuprofen (Advil, Motrin IB, others).
- Colchicine (Colcrys)
- Corticosteroid, such as prednisone.
Medical procedures and surgery
If anti-inflammatory treatments don’t correct the problem or you have or are likely to have tamponade, your cardiologist may recommend one of the following procedures to drain fluids or prevent fluids from accumulating again.
- Drain the fluid. Your doctor can enter the pericardial space with a needle and then use a small tube (catheter) to drain fluid a procedure called pericardiocentesis. The doctor uses echocardiography or a type of X-ray imaging called fluoroscopy to guide the catheter to the right position. In most cases, the catheter will be left in place to drain the area for a few days to help prevent the fluid from building up again.
- Open-heart surgery. If there’s bleeding into the pericardium, especially due to recent heart surgery or other complications, open-heart surgery may be done to drain the pericardium and repair damage. Occasionally, a surgeon may also create a “passage” that allows fluid to drain as necessary into the abdominal cavity, where it can be absorbed.
Depending on how quickly pericardial effusion develops, the pericardium can stretch somewhat to accommodate the excess fluid. However, too much fluid causes the pericardium to put pressure on the heart, which prevents the chambers from filling.
This condition, called tamponade, results in poor blood flow and a lack of oxygen to the body. Tamponade is life-threatening and requires emergency care.