Pericardial effusion is a formation of excess fluid in the double layer of the heart pericardium (sac-like structure around the heart). The pericardial sac or pericardium comprises a thin visceral pericardium, which includes a single layer of adherent cells. The space between the layers contains a thin layer of fluid. A healthy pericardial sac contains 15 to 20 ml of serous fluid. Fluid may be exudative, transudative, or sanguineous.

When the pericardium is injured, then becomes inflamed and can lead to excess fluid buildup. Some other things also cause inflammation in the pericardium and form an extra fluid in the spaces, such as bleeding, cancer, etc. Pericardial effusion can put excess pressure on the heart and affect the heart’s working. If the pericardial effusion is left untreated, it may lead to heart failure and cause death at an extreme level. Effusion can occur in any body part, and fluid builds up in the lungs, such as pleural effusion. 

Causes of pericardial effusion

Pericardial effusion can be caused by inflammation in the pericardium due to illness. Certain cancers also cause large flows. Collection of blood and blockage of the pericardial fluid within the pericardium can also lead to this condition. Causes of pericardial effusion;

  • Autoimmune disorders (lupus or rheumatoid arthritis)
  • Chest injury or trauma 
  • Cancer in the heart or pericardium (spread from the other parts of the body)
  • Hypothyroidism (underactive thyroid)
  • Exposure to toxins 
  • Radiotherapy for cancer in the heart can also cause pericardial effusion 
  • Cancer effusion 
  • Inflammation of pericardium due to heart attack or after heart surgery
  • Bacterial, viral, or fungal infection 
  • Uremia (due to kidney damage, waste material collects in the blood)
  • Misuse of some drugs 
  • Metabolic causes such as kidney failure
  • Heart problems 
  • Medical causes 
  • Radiations
  • Whipple’s disease 
  • Sarcoidosis (inflammatory conditions that affect many body organs)  

Symptoms of the pericardial effusion

Signs and symptoms of pericardial effusion can be unnoticeable. In severe cases, signs and symptoms include;

  • Chest discomfort while lying down 
  • Shortness of breath
  • Chest fullness
  • Chest pain behind the breastbone 
  • Lightheadedness
  • Enlarged neck veins 
  • Fast breathing 
  • Pain in the upper right abdomen 
  • Bloating (Abdominal distension) 
  • Fainting 
  • Swelling in the stomach or legs 
  • Heart palpitation 
  • Dizziness 
  • Anxiety 
  • Cyanosis (low blood oxygen level causes blue or grey lips and under fingernails)
  • Trouble in swallowing 
  • Coughing 
  • Fever 
  • Diarrhea 

When to see the doctor:

Seek immediate medical attention if the symptoms are;

  • Chest pain lasts more than a few minutes
  • Difficulty in breathing with pain 
  • Unexplained fainting spell

The doctor sees the following signs;

  • Low blood pressure 
  • Accelerated or rushed pulse 
  • Check heartbeat by stethoscope 

A possible sign of chronic heart failure include;

  • Fast breathing 
  • Physical weakness
  • Distended neck veins 
  • Fluid builds up in the abdomen
  • Leg swelling 

Complications in pericardial effusion

  • Excess fluid puts pressure on the heart 
  • Strain fills the blood in chambers 
  • Lack of oxygen to the body 

Diagnosis of pericardial effusion

Doctors do physical and medical tests for diagnosis. During a physical examination, the doctor asks about symptoms and history. Listen to heartbeats by stethoscope. 

Tests of pericardial effusion

Tests identify the causes of pericardial effusion; tests include;

 Echocardiogram:

Sound waves are used in echocardiograms to create a clear image of the heart in motion. An echocardiogram shows the work of the heart pumping blood and determines the amount of fluid between the pericardium’s two layers. Heart function is decreased due to the pressure on the heart. 

Electrocardiogram:

It is a painless test that measures the electrical activity of the heart. Sticky patches are placed or attached to the chest and arms or legs. Wires of electrodes are connected to the computer, which shows the test results. 

Chest X-ray:

Chest X-ray can tell the shape and size of the heart. If the effusion is significant, an X-ray shows the sign of an enlarged heart.

CT and MRI scans are also suitable for the detection of pericardial effusion. But they are not used generally. 

Treatment of pericardial effusion

Treatment of pericardial effusion depends on the following factors;

  •  Amount of fluid that buildup
  • Cause of pericardial effusion 
  • The severity of the effusion 
  • Risk of cardiac tamponade (decreased heart function due to pressure on the heart)

Medications of pericardial effusion

The following medications are used to treat the inflammation of pericardium;

  • NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen 
  • Aspirin 
  • Colchicine
  • Corticosteroids

Surgery

Doctors do some surgeries to drain out the excess fluid from the pericardium if;

  • Medications don’t work correctly to treat pericardium 
  • Symptoms increase with large pericardial effusion and increase the risk of cardiac tamponade
  • Cardiac tamponade 

Some drainage procedures are;

Fluid drainage:

A doctor or health care provider uses a needle in the pericardial space and inserts a catheter to drain the fluid. Echocardiography, an imaging technique, is used to guide the work. Catheter left in the pericardial space to prevent fluid buildup in the future. 

Open heart surgery:

Suppose there is any bleeding in the pericardium due to heart surgery and another complicating factor. In that case, open heart surgery may drain all the fluid with blood from the pericardium and repair the damage. 

Removal of the pericardium:

Removal of the pericardium is called pericardiectomy. The surgeon recommends removing the entire pericardium when the pericardial effusion occurs continuously after drainage.

Pericardiocentesis:

Removal of small fluid through a needle from the pericardium to a test infection and tumor. 

Pericardiostomy:

When the pericardial effusion is extensive and pericardiocentesis doesn’t get enough to treat pericardial effusion, then the following procedures are used;

    • Subxiphoid pericardiotomy (the doctors make a small incision under the breastbone and remove a small part of the pericardium to remove excess fluid)
    • Video-assisted thoracoscopic surgery (a small incision is made in the chest wall to diagnose accurately. A Camera is inserted from this whole, and excess fluid is drained.) 

Alternative surgeries:

Alternative surgeries for the removal of excess fluid are;

  • Percutaneous balloon pericardiotomy.
  • Intrapericardial sclerosis. 

Strategies to improve pericardial effusion

  • Oxygen therapy
  • Diuretics 
  • Medications 

Lab tests

Some possible lab tests are the following to find out the reason;

  • CBC (complete blood count)
  • Troponin
  • B-type natriuretic peptide
  • TSH (stimulating thyroid hormone)
  • Immune system test 

Recovery time

Pericardial effusion recovery may take some months or weeks. It depends on the causes and severity of the pericardial effusion. 

References

  • https://www.mayoclinic.org/diseases-conditions/pericardial-effusion/symptoms-causes/syc-20353720
  • https://my.clevelandclinic.org/health/diseases/17351-pericardial-effusion
  • https://www.webmd.com/heart-disease/guide/pericardial-effusion
  • https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/pericardial-effusion-treatment
  • https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=abr9819