Pericardial Effusion

What is pericardial effusion?

Pericardial effusion is the buildup of extra fluid in the space around the heart. If too much fluid builds up, it can put pressure on the heart. This can prevent it from pumping normally.

A fibrous sac called the pericardium surrounds the heart. This sac consists of two thin layers. Normally, there is a small amount of fluid between them. The fluid reduces friction between the two layers as they rub against each other. In some cases, extra fluid can build up between these two layers leading to a pericardial effusion.

A little fluid won’t cause much of a problem. But, if too much fluid builds up it can make it difficult for the heart to expand normally. This condition is called cardiac tamponade. It usually requires emergency treatment. Because of the extra pressure, less blood can enter the heart from the body. All of this can reduce the amount of oxygenated blood going out to the body. But not all pericardial effusions cause cardiac tamponade.

In some cases, pericardial effusion develops quickly. This is known as acute pericardial effusion. Other times, the fluid builds up slowly. This is known as subacute pericardial effusion. Chronic pericardial effusion is when cardiac effusion happens more than once over time.

What causes pericardial effusion?

A number of conditions can cause excess fluid and inflammation in the pericardial sac, such as:

• Cancer (spread from another part of the body or from the heart tissue itself)
• Infection of the pericardial sac
• Inflammation of the pericardial sac due to a heart attack
• Injury (including injury from medical procedures on the heart)
• Immune system problems
• Metabolic causes, like kidney failure with uremia
• Reactions to certain medicines
• Radiation

Sometimes the cause of fluid buildup is unknown.

What are the symptoms of pericardial effusion?

You may not have any symptoms. This is more often the case with a mild problem. You might be more likely to have symptoms from whatever is causing the pericardial effusion. For example, you might have fever if you have an infection of the pericardial sac.

When effusion is more severe, you may have symptoms such as:

• Chest pain or discomfort
• Enlargement of the veins of the neck
• Fainting
• Fast breathing
• Increased heart rate
• Nausea
• Pain in the right upper abdomen
• Shortness of breath
• Swelling in the arms and legs

If the effusion is very severe, it can also lead to very low blood pressure. This can cause symptoms of shock which include:

• Cool arms and legs
• Pale skin
• Less urine output

Shock is a medical emergency.

The symptoms of pericardial effusion can be like other health problems. Make sure to see your healthcare provider for a diagnosis.

How is pericardial effusion diagnosed?

The process starts with a medical history and a physical exam. Your healthcare provider will ask about your symptoms and past medical conditions. For symptoms of shock, it is important to find the cause quickly.

Tests may also be done, such as:

• Chest X-ray to see the heart anatomy
• CT scan of the chest or MRI of the heart
• Echocardiogram to examine fluid around the heart and heart motion
• EKG or ECG to analyze the heart’s electrical rhythm

Doctors must try to diagnose the cause of the pericardial effusion with tests such as:

• Analysis of the fluid removed from around the heart to check for cancer or infection
• Different blood tests to diagnose infection, immune system, and metabolic problems

How is pericardial effusion treated?

Treatment will depend on your symptoms, your age, and your general health. It will also depend on how severe the condition is, and what caused it. Chronic and acute pericardial effusions may need different treatment.

If a pericardial effusion is not severe, treatment may include:

• Careful monitoring with multiple echocardiograms
• Therapy aimed at the cause of the pericardial fluid buildup, like antibiotics for a bacterial infection
• Treatment of pain with aspirin or another medicine

A severe pericardial effusion may need to be drained. The fluid is drained with a procedure called pericardiocentesis. This procedure uses a needle and a thin, flexible tube (catheter) to drain the fluid.

In some cases, the pericardial sac may be drained during surgery. The surgeon may remove a piece of the pericardium. This is done to help diagnose the cause of the effusion. It can also prevent the fluid from building up again. Your doctor might be more likely to do this if you have had chronic pericardial effusion.

Symptoms often improve greatly after the excess fluid is drained. The outcome may depend on the cause and severity of the condition, the speed of treatment, and your overall health.

 

What are the complications of pericardial effusion?

Many times, there are no complications of pericardial effusion. The most serious possible complication is cardiac tamponade. If untreated, it can lead to shock. This can cause serious complications. For example, reduced blood flow to the kidneys during shock can cause the kidneys to fail. Untreated, shock can lead multiple organs to fail, causing death.

What can I do to prevent pericardial effusion?

You can reduce your risk of some of the medical problems that can lead to pericardial effusion. For example, take care of your heart by:

• Avoiding excess alcohol.
• Eating a heart-healthy diet.
• Getting enough exercise and maintaining a healthy weight.
• Seeing a doctor regularly to treat your medical problems.

Many cases of pericardial effusion are not preventable.

When should I call the doctor?

If you have any symptoms of pericardial effusion, call your doctor right away. Call 911 if you have trouble breathing, chest pain, or symptoms of shock.

Key points

• A pericardial effusion is when excess fluid builds up in the pericardial sac around the heart. This can happen for a variety of reasons.
• Some pericardial effusions are small. These are unlikely to cause symptoms or major problems themselves.
• If the pericardial effusion is large, it can make the heart unable to pump normally. This is a medical emergency.
• Doctors can monitor small pericardial effusions and treat the underlying causes.
• A person with a large pericardial effusion might need a procedure to remove fluid from around the heart.
• You should seek medical attention right away if you have symptoms like severe chest pain or difficulty breathing.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions.