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Pericardial effusion occurs when fluid accumulates in the space surrounding the heart, known as the pericardium. This condition can arise from various causes, including infections, physical trauma, or other health issues. A rapid or excessive fluid buildup can squeeze the heart, potentially leading to a critical health crisis.
If the fluid gathers gradually, the pericardium has the ability to expand, accommodating the additional fluid. However, a swift accumulation does not allow the pericardium to adjust, resulting in increased pressure on the heart. This pressure restricts the expansion of the heart’s chambers, limiting their capacity to fill with blood. Consequently, the heart’s blood output decreases, which can reduce blood flow to the body’s organs.
Without proper treatment, this condition might progress to heart failure or become fatal in severe cases.
Symptoms
Pericardial effusion might not always manifest noticeable symptoms, especially if the accumulation of fluid is gradual.
However, when symptoms of pericardial effusion do present, they can include:
- Dizziness or a faint feeling
- Discomfort while breathing in a lying down position
- Difficulty breathing or shortness of breath (known as dyspnea)
- A sensation of fullness in the chest
- Swelling in the legs or abdomen
- Pain in the chest, often located behind the breastbone or on the left side
Immediately call your local emergency services if you experience persistent chest pain lasting more than a few minutes, if breathing becomes difficult or painful, or if you faint without any clear reason.
If you notice shortness of breath, it’s important to schedule a visit with your healthcare provider.
Causes
Pericardial effusion is a condition characterized by the accumulation of fluid around the heart. The causes vary significantly between developed and developing countries. In developed nations, the exact cause often remains unidentified, while in developing regions, tuberculosis is frequently identified as the primary cause. This condition is commonly associated with, or a result of, pericarditis—a condition involving inflammation of the pericardium.
Various factors can lead to the development of pericardial effusion, such as:
- Infections: Viral, bacterial (including tuberculosis and HIV), fungal, and parasitic infections can lead to pericardial effusion. It’s important to note that pericardial effusion itself is not contagious.
- Cancer: The presence of tumors in the heart or the spread of tumors from other parts of the body can adversely affect the pericardium.
- Immune system conditions or inflammatory disorders: Conditions such as lupus, rheumatoid arthritis, and Sjögren’s syndrome can cause pericardial effusion.
- Hormonal disorders or problems: An underactive thyroid gland (hypothyroidism), which results in insufficient thyroid hormone production, is an example.
- Trauma: Chest injuries from blunt impacts (e.g., car accidents) or penetrative trauma (e.g., stabbings or gunshot wounds) can result in pericardial effusion.
- Heart or circulatory problems: Conditions including heart attacks, heart valve diseases, and aortic dissection (a separation or tear in the inner layer of the aorta) can lead to pericardial effusion.
- Medical causes: The condition can arise following heart surgery, radiation therapy for cancer, or as a side effect of certain medications.
- Other causes: Heart failure, chronic kidney disease, kidney failure, and liver cirrhosis can also result in pericardial effusion.
Diagnosis
The diagnosis of pericardial effusion involves inquiring about the symptoms and medical background, listening to the heart using a stethoscope, and conducting a physical examination.
If symptoms are absent, diagnosis often occurs incidentally through medical imaging ordered for other purposes, such as a chest X-ray following a car accident. In either case, when pericardial effusion is suspected, healthcare providers may order multiple tests to confirm the diagnosis.
Tests that may be ordered include:
- Echocardiogram: This test can detect reduced heart function caused by pressure on the heart, known as tamponade. It can also indicate the level of fluid buildup between the layers of the pericardium. An echo uses sound waves to create moving images of the heart, revealing the heart’s chambers and its blood-pumping ability.
- Chest X-ray: If the effusion is significant, an enlarged heart may be visible on a chest X-ray. This test can examine the size and shape of the heart via a chest X-ray.
- Magnetic resonance imaging (MRI) and computed tomography (CT) scans: In some cases, pericardial effusion is discovered when these tests are performed for different reasons.
- Electrocardiogram (ECG or EKG): During the procedure, sticky patches called electrodes are positioned on the chest, and sometimes on the arms and legs. These electrodes are connected to a computer, which shows the results of the test. An EKG measures the heart’s electrical activity. The patterns in the signals may be analyzed to identify signs of cardiac tamponade.
Treatment
The approach to treating pericardial effusion depends on its size, symptoms, and underlying cause. If the effusion is small to medium-sized and not symptomatic, observation with regular monitoring is typically sufficient. However, if it rapidly increases in size, leads to symptoms, or is linked to serious conditions such as trauma or cancer, prompt intervention becomes necessary. In instances of large effusion or cardiac tamponade, urgent medical attention is vital.
Treatment options include:
- Medications: Treatment for pericardial effusion often involves antibiotics to combat infections such as tuberculosis, and anti-inflammatory medications are commonly prescribed to alleviate inflammation and reduce swelling. Examples include aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, colchicine, or corticosteroids such as prednisone.
- Surgery or other procedures: If medications fail to address the pericardial effusion, or if a large effusion leads to symptoms or poses a risk of cardiac tamponade, the healthcare provider may suggest drainage procedures or surgery. These interventions aim to alleviate the effusion and prevent future fluid accumulation.
- Pericardiocentesis or needle aspiration. To drain excess fluid from the pericardium, a spot on the chest is numb and imaging like echocardiography or fluoroscopy is used for guidance. The healthcare provider uses a needle to enter the space around the heart and inserts a small tube called a catheter to drain the fluid. Sometimes, they may leave a small tube in the pericardium to drain fluid for a few days until it is completely removed.
- Open-heart surgery. In certain situations, it may be imperative to perform pericardial drainage to alleviate pressure and manage any related injuries. Establishing a route for fluid drainage into the abdominal cavity may be necessary, especially when there’s bleeding in the pericardium, notably after recent cardiac surgery or in the presence of complications.
- Pericardiectomy. This procedure involves the removal of all or a portion of the pericardium, the protective sac around the heart. This may be suggested when drainage procedures fail to resolve recurrent pericardial effusions.
