Definition
Pericardial effusion is an abnormal amount of fluid buildup between the heart and pericardium (the sac surrounding the heart). If the pericardium becomes diseased or damaged, the resulting inflammation can lead to pericardial effusion. This condition is usually associated with many different medical conditions and can arise from accumulation of blood after a surgical procedure or injury. When the amount of fluid exceeds the pericardium's top capacity, pericardial effusion puts pressure on the heart, causing poor heart function. Left untreated, pericardial effusion can cause heart failure or even death.
Symptoms
Pericardial effusion signs and symptoms may include:
- Fever
- Tiredness
- Shortness of breath or difficulty breathing (dyspnea)
- Chest pain
- Nausea, vomiting
- Fast heart beat
- Cough
Causes
Inflammation of the pericardium (pericarditis) is a response to disease, injury or an inflammatory disorder that affects the pericardium. As the pericardium becomes inflamed, excess fluid is produced, leading to pericardial effusion. Pericardial effusion may also occur when the flow of pericardial fluids is blocked or when blood accumulates within the pericardium.
Specific causes of pericardium effusion may include:
· Viral, bacterial, fungal or parasitic infections
· Cancer
· Injury to the pericardium or heart from a medical procedure
· Autoimmune disorders (rheumatoid arthritis or lupus)
· Kidney failure
· Underactive thyroid (hypothyroidism)
· Radiation therapy for cancer
· Chemotherapy treatment for cancer
· Trauma or puncture wound near the heart
· Certain prescription drugs
Complications
The pericardium can hold only a limited amount of excess fluid without causing problems to the heart. When too much liquid collects, the pericardium expands inward, toward the heart and puts pressure on it. In turn, the pumping chambers of the heart fail to fill completely and one or more chambers may partly collapse. If this occurs, a condition called tamponade arises, leading to poor blood circulation and an inadequate supply of oxygen to the body. If left untreated, Tamponade can be a life-threatening.
Treatment
Treatment for pericardial effusion typically depends on how much fluid has accumulated, what is causing the effusion, and whether pericardial effusion has caused or is likely to cause decreased heart function. Treatment options may include:
- Medications to help reduce inflammation (Aspirin, Nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin (Indocin) or ibuprofen (Advil, Motrin IB, others), Colchicine (Colcrys))
- Corticosteroid injections (prednisone)
Additional treatment options to help drain fluids or prevent fluid buildup from accumulating again may include the following:
- Pericardiocentesis: A procedure that involves the insertion of a small tube (catheter) through the chest into the pericardial effusion to drain fluid from the pericardium.
- Open heart surgery: A procedure that drains the pericardium and creates a passageway that allows it to drain as necessary into the abdominal cavity where the fluid can be absorbed.
- Intrapericardial sclerosis: A procedure that involves injecting a solution into the space between the two layers of the pericardium that essentially seals the layers together.
- Pericardiectomy: Surgical removal of all or a portion of the pericardium.
Many pericardial effusions are caused by particular medical conditions (HIV infection, lupus, or tuberculosis). In these cases, treating the original medical condition will often help treat the pericardial effusion.
