Pericardial Effusion: Causes, Symptoms, Complications, Diagnosis and Treatment

It is an abnormal accumulation of fluid in the pericardial cavity.

The pericardium is a hard, layered sac. When your heart beats, it easily slides into it. Typically, between the two layers of the sac are 2 to 3 tablespoons of light yellow pericardial fluid. That fluid helps your heart move more easily within the sac.

Due to the limited amount of space in the pericardial cavity, the accumulation of fluid leads to an increase in intrapericardial pressure that can adversely affect cardiac function.

Pericardial effusion is usually the result of an altered balance between the production and reabsorption of pericardial fluid, or a structural abnormality that allows fluid to enter the pericardial cavity.

This can prevent your heart from pumping normally because the extra fluid causes compression. Pericardial effusion can lead to a life-threatening condition called cardiac tamponade . In this condition, your heart becomes too compressed to function normally. Cardiac tamponade is life threatening and must be treated immediately.

Causes

There are many causes for fluid buildup in the pericardium, including:

Symptoms

When the inflammation of the sac causes a pericardial effusion, the main symptom is chest pain. It may be worse when you breathe deeply and better when you lean forward.

Other symptoms can include:

  • Fever.
  • Fatigue.
  • Muscle pains.
  • Short of breath.
  • Nausea, vomiting, and diarrhea (if you have a virus).

When there is no inflammation of the sac, there are often no symptoms.

Large and severe pericardial effusions, or smaller ones that develop rapidly, can cause symptoms including:

  • Short of breath.
  • Palpitations (feeling that the heart is beating or beating fast).
  • Dizziness or fainting
  • Fresh and moist skin.
  • A pericardial effusion with these symptoms is a medical emergency and can be life-threatening.

Complications

Depending on how quickly the pericardial effusion develops, the pericardium may stretch a bit to accommodate the excess fluid. However, too much fluids put pressure on the heart on the pericardium, preventing the chambers from filling completely.

This condition, called tamponade (tampon-AYD), causes poor blood circulation and an inadequate supply of oxygen to the body. Tamponade is life-threatening and requires emergent / urgent care.

Diagnosis

Because they often cause no symptoms, they are often discovered after routine test results are abnormal. These tests can include:

Physical exam: A doctor may hear abnormal sounds in the heart that may suggest inflammation. However, pericardial effusions usually cannot be found through a physical exam.

Electrocardiogram: Electrodes placed on your chest track the electrical activity of the heart. Certain patterns on an EKG can indicate a pericardial effusion or the inflammation that leads to it.

X-ray film of the chest: The silhouette of the heart in one can be enlarged. It is a sign of a pericardial effusion.

If one is suspected, the best test to confirm it is an echocardiogram (ultrasound of the heart) because your doctor could easily see any excess fluid.

Once the spill is identified, its size and severity are determined. Most of the time, it is small and does not cause serious problems. If it is large, it can compress your heart and hinder its ability to pump blood. This condition, called cardiac tamponade, is life-threatening.

To find the cause of a pericardial effusion, your doctor may take a sample of the pericardial fluid . In this procedure, called pericardiocentesis, a doctor inserts a needle through your chest into your pericardial effusion and takes in some fluid.

Treatment

It depends on its severity and cause. Small effusions that have no symptoms and are due to known causes (such as kidney failure) do not require special treatment.

For pericardial effusions due to sac inflammation, treating the inflammation also treats the effusion.

In that case, you can be given:

  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as Aleve, Indocin, and Motrin.
  • Corticosteroids, such as prednisone and Solu-Medrol.
  • Colchicine.

If there is a severe infection or heart failure (cardiac tamponade), the extra fluid must be drained immediately. Drainage is done in two ways:

Pericardiocentesis: A doctor inserts a needle through the chest into the pericardial effusion. A catheter is placed in the fluid and suctioned out.

Pericardiectomy or pericardial window: A surgeon makes an incision in the chest, stretches out the hand, and cuts part of the pericardium. This drains the pericardial effusion and generally prevents it from coming back. The procedure requires general anesthesia and is more risky than pericardiocentesis .