Pericardial Effusion

A pericardial effusion is a condition in which there is an excess of fluid between your heart and the sac surrounding the heart, which is termed the pericardium. Although most of them are not harmful, they can sometimes make the heart work poorly.

The pericardium is a tough and layered sac. When the heart beats, it slides easily within it. The sac’s two layers have around 2-3 tablespoons of clear and yellow pericardial fluid. When you suffer from pericardial effusion, an excess of fluid sits in the sac. Small ones may contain 100 milliliters of fluid, while large ones may have more than 2 liters.

Symptoms

In some cases, you might have significant pericardial effusion without having any signs or symptoms. This may be the case if the fluid has increased slowly.

When symptoms of pericardial effusion occur, they might include one or more of the following:

Shortness of breath or difficulty while breathing
Chest pain, which occurs usually behind the breastbone or on the left side of the chest
Discomfort in breathing while lying down
Swelling in the abdomen or the legs
Chest fullness

If you feel chest pain that lasts over a few minutes, then it might be best to call a doctor or emergency services.

Causes

Pericardial effusion may be caused due to inflammation of the pericardium in response to an ailment or injury. It might also occur when the flow of pericardial fluid is blocked or when blood collects within the pericardium, such as from chest trauma. Some other causes of this condition can include the following:

Autoimmune disorders like lupus or rheumatoid arthritis
Inflammation of the pericardium after a heart attack or a heart surgery
Spread of cancer particularly lung cancer, breast cancer, leukemia, melanoma, non-Hodgkin’s lymphoma, or Hodgkin’s disease
Cancer of the pericardium or heart
Chemotherapy treatments for cancer
Radiation therapy treatment for cancer if the heart was within the radiation field
Waste products in the blood caused by kidney failure
Underactive thyroid
Trauma or puncture wound near the heart after an open-heart surgery
Viral, bacterial, parasitic, or fungal infections
Certain prescription drugs

Diagnosis

Since in many cases, a pericardial effusion has no symptoms, they can include the following exams:

Physical Examination

During a physical exam, your doctor might hear abnormal sounds over the heart which might suggest an inflammation. However, pericardial effusions can’t be usually found through a physical exam.

Echocardiogram

This method uses sound waves in order to create real-time images of the heart. This test can allow the doctor to see how much fluid has collected in the space between the two layers of your pericardium. An echocardiogram can also help in showing how effectively your heart is pumping blood. It may also help in diagnosing tamponade or a collapse in any of the chambers of the heart.

Electrocardiogram

In this method, electrodes placed on your chest help to trace the heart’s electrical activity. Certain patterns on the electrocardiogram can signal a pericardial effusion or the inflammation that causes it. If it is suspected, an echocardiogram may be used to confirm it.

Once the effusion has been identified, your doctor will need to figure out its size and severity. Usually, it’s small and doesn’t cause any serious problems. However, if it is large, it may even compress your heart and hamper its blood-pumping ability. Known as cardiac tamponade, this condition can be life-threatening.

Treatment

Treatment for pericardial effusion generally depends on the amount of fluid present, as well as the underlying cause, and whether you have or not you are likely to be having cardiac tamponade. Treating the cause of pericardial effusion may often correct the problem. If you don’t have tamponade or there is no threat to it, then your doctor might prescribe an anti-inflammatory drug in order to reduce the pericardium. If anti-inflammatory treatments don’t correct the problem, or you are likely to have tamponade, then your cardiologist might recommend one of the following procedures for draining out the fluid or to prevent further accumulation of fluid.

Drain the fluid

Your doctor can insert a needle into the pericardial space and then use a small tube or catheter to drain fluid. This procedure is termed pericardiocentesis. In order to guide the catheter into the right position, your doctor is going to use echocardiography or a type of X-ray imaging known as fluoroscopy.

Open-heart surgery

If there is bleeding into the pericardium, caused by recent heart surgery or any other complications, then open-heart surgery might be done to drain the pericardium and repair any damage. Occasionally, a surgeon might also create a passage that can allow fluid to drain into the abdominal cavity, where it can be absorbed.

Open the layers

Although performed rarely, there is a procedure called balloon pericardiotomy, in which a deflated balloon is inserted between the layers of the pericardium and then inflated to stretch them.

Remove the pericardium

For people who are having recurring pericardial effusions despite undergoing catheter drainage, the surgical removal of all or part of the pericardium might be considered.

Complications

Depending on how fast the pericardial effusion develops, the pericardium can stretch somewhat to accommodate any excess fluid. However, too much fluid can cause the pericardium to put pressure on the heart, which may prevent the chambers from filling completely. This condition, which is known as tamponade, can result in poor blood flow as well as a lack of oxygen to the body. Tamponade is not only life-threatening but can also require emergency care.

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Pericardial Effusion