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.