Pericardial effusion

A thin membrane called pericardium surrounds your heart. The membrane protects your heart against infections and prevents from expanding too much. When there is an abnormal fluid between your heart and pericardium, the condition is termed as pericardial effusion. Your normal pericardial sac consists of nearly 30 to 50 mL of fluid. In pericardial effusion, the volume of abnormal fluid increases up to two liters.

When there is any inflammation, your heart releases excess fluid and accumulates in the pericardial sac. Usually, in normal conditions, the fluid around your heart is continuously produced and drained, keeping the levels of fluid constant. But, in conditions such as heart attack or heart failure, the fluid in the pericardial sac is not drained properly. Your body, however, will continue to produce fluid causing excess fluid around your heart.

In most cases, inflammation leads to pericardial effusion. If the flow of fluid is blocked or when the blood is accumulated in the pericardium, it may result in pericardial effusion. Sometimes, the exact cause is never found. A wide range of conditions may cause pericardial effusion that includes the following:

  • Inflammation of pericardium due to heart surgery
  • Autoimmune diseases such as lupus, ankylosing spondylitis, and rheumatoid arthritis
  • Infections such as bacterial, viral, or tuberculous.
  • Metastatic cancer, especially lung cancer, breast cancer, Hodgkin’s disease, and melanoma
  • Kidney failure
  • Chest trauma
  • Radiation therapy and chemotherapy

Sometimes, fluid in the pericardium increases slowly without any signs and symptoms. But, if there is sudden increase in the pericardial fluid, it may cause the following pericardial effusion symptoms:

  • Shortness of breath
  • Discomfort while breathing
  • Chest pain
  • Chest fullness

The risk factors for pericardial effusion include:

  • Hypothyroidism
  • Infectious or acute pericarditis
  • Acute myocardial infarction
  • Whipple’s disease
  • Severe chronic anemia

If the condition is not treated, it may lead to chronic pericardial effusion, where the condition lasts more than six months.

In severe cases, pericardial effusion may cause cardiac tamponade. The symptoms of cardiac tamponade include blue tinge on the lips and skin, shock, and change in the mental status. This condition is considered as a medical emergency and requires an immediate draining of the fluids.

Your doctor initiates the diagnosis by a complete medical examination. If pericardial is suspected, your doctor might order the following tests.

  • Echocardiogram: The test uses sound waves and identifies the extent of pericardial effusion.
  • Electrocardiogram: The test records the electrical signals of your heart. Electrocardiogram can reveal the presence of cardiac tamponade.
  • Other imaging studies: Other imaging techniques such as X-ray, magnetic resonance imaging, and computed tomography scan might be recommended. X-ray shows the enlargement of your heart. Computed tomography scan and magnetic imaging scan help to detect pericardial effusion. These tests provide a detailed image of your heart and help to rule out other conditions.

Sometimes, your pericardial fluid is aspirated to analyze the protein level, cell count and for culture. If your doctor suspects malignant pericardial effusion, then pericardial biopsy might be suggested.

Your doctor would suggest the appropriate pericardial effusion treatment based on severity, underlying cause, and extent of risk for developing cardiac tamponade.

The primary goal of medical management is to treat the underlying cause that results in pericardial effusion. Your doctor might recommend the following medications.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs): These are used to treat the inflammatory conditions causing a pericardial effusion. The drugs used are aspirin or ibuprofen.
  • Diuretics: If pericardial effusion is caused due to heart disease, diuretics, and the heart failure drugs might be prescribed.
  • Antibiotics: If the cause is due to an infection, antibiotics are prescribed.

If you have a large amount of fluid in the pericardial sac that might cause cardiac tamponade, then draining the fluid would be the best option. For treating the large pericardial effusions, your doctor might suggest any of the following surgical procedures.

  • Ultrasound-guided pericardiocentesis: This is the most effective technique in which your doctor inserts a needle into the pericardial space and then drains the excess pericardial fluid using a small catheter.
  • Subxyphoid pericardiostomy: This procedure is preferred when the pericardial effusion cannot be managed with medication or draining the fluid. It is a minimally invasive procedure where the pericardium is opened slightly to drain the fluid.
  • Balloon pericardiotomy: It is a nonsurgical procedure where an X-ray image will guide to view the pericardium and involves placing a balloon dilating catheter. It is preferred in rare conditions.