Pericardial effusion
Overview
Pericardial
effusion (per-e-KAHR-dee-ul uh-FU-zhun) is the buildup of too much fluid in the
double-layered, saclike structure around the heart (pericardium).
The
space between these layers typically contains a thin layer of fluid. But if the
pericardium is diseased or injured, the resulting inflammation can lead to
excess fluid. Fluid can also build up around the heart without inflammation,
such as from bleeding, related to a cancer or after chest trauma.
Pericardial effusion can put pressure on the heart, affecting
how the heart works. If untreated, it may lead to heart failure or death in
extreme cases.
Symptoms
Pericardial
effusion may not cause any noticeable signs and symptoms, particularly if the
fluid has increased slowly.
If pericardial effusion signs and symptoms do occur, they might
include:
·
Shortness of breath or difficulty breathing (dyspnea)
·
Discomfort when breathing while lying down
·
Chest pain, usually behind the breastbone or on the left side of
the chest
·
Chest fullness
·
Lightheadedness or feeling faint
·
Swelling in the abdomen or legs
When to see a doctor
Call
911 or your local emergency number if you feel chest pain that lasts more than
a few minutes, if your breathing is difficult or painful, or if you have an unexplained
fainting spell.
See your health care provider if you have shortness of breath.
Causes
Pericardial
effusion can result from inflammation of the pericardium (pericarditis) after
an illness or injury. In some settings, large effusions may be caused by
certain cancers. A blockage of pericardial fluids or a collection of blood
within the pericardium also can lead to this condition.
Sometimes
the cause can't be determined (idiopathic pericarditis).
Causes of pericardial effusion may include:
·
Autoimmune disorders, such as rheumatoid arthritis or lupus
·
Cancer of the heart or pericardium
·
Spread of cancer (metastasis), particularly lung cancer, breast
cancer or Hodgkin's lymphoma
·
Radiation therapy for cancer if the heart was in the area of the
radiation
·
Chest trauma
·
Inflammation of the pericardium following a heart attack or
after heart surgery or a procedure where the heart's lining is injured
·
Underactive thyroid (hypothyroidism)
·
Use of certain drugs or exposure to toxins
·
Viral, bacterial, fungal or parasitic infections
·
Waste products in the blood due to kidney failure (uremia)
Complications
A
potential complication of pericardial effusion is cardiac tamponade
(tam-pon-AYD). In this condition, the excess fluid within the pericardium puts
pressure on the heart. The strain prevents the heart chambers from filling
completely with blood.
Cardiac tamponade results in poor blood flow and a lack of
oxygen to the body. Cardiac tamponade is life-threatening and requires
emergency medical treatment.
Diagnosis
To diagnose pericardial
effusion, the health care provider will typically perform a physical exam and
ask questions about your symptoms and medical history. He or she will likely
listen to your heart with a stethoscope. If your health care provider thinks
you have pericardial effusion, tests can help identify a cause.
Tests
Tests to
diagnose or confirm pericardial effusion may include:
·
Echocardiogram. Sound
waves are used to create pictures of the heart in motion. An echocardiogram
shows the heart chambers and how well the heart is pumping blood. The test can
help determine the amount of fluid between the two layers of the pericardium.
An echocardiogram may also show decreased heart function due to pressure on the
heart (tamponade).
·
Electrocardiogram (ECG or EKG). This
quick and painless test measures the electrical activity of the heart. Sticky
patches (electrodes) are placed on the chest and sometimes the arms and legs.
Wires connect the electrodes to a computer, which displays the test results.
Your cardiologist or another health care provider can look for signal patterns
that suggest cardiac tamponade.
·
Chest X-ray. An
X-ray image of the chest allows a health care provider to check the size and
shape of the heart. A chest X-ray can show signs of an enlarged heart if the
effusion is large.
computed tomography (CT) and
Magnetic resonance imaging (MRI) scans can detect pericardial effusion,
although they're generally not used to look for the condition. However,
pericardial effusion may be diagnosed when these tests are done for other
reasons.
Treatment
Treatment for pericardial
effusion depends on:
·
The amount of fluid buildup
·
The cause of pericardial effusion
·
The presence or risk of cardiac tamponade
Medications
If you don't have cardiac
tamponade or there's no immediate threat of cardiac tamponade, your health care
provider might prescribe one of the following medications to treat inflammation
of the pericardium:
·
Aspirin
·
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
(Advil, Motrin IB, others)
·
Colchicine (Colcrys, Mitigare)
·
A corticosteroid, such as prednisone
Surgery or
other procedures
Your
health care provider may recommend procedures to drain a pericardial effusion
or prevent future fluid buildup if:
·
Medications don't correct the pericardial effusion
·
A large effusion is causing symptoms and increasing the risk of
cardiac tamponade
·
You have cardiac tamponade
Drainage procedures or surgery
to treat pericardial effusion may include:
·
Fluid drainage (pericardiocentesis). A
health care provider uses a needle to enter the pericardial space and then
inserts a small tube (catheter) to drain the fluid. Imaging techniques,
typically echocardiography, are used to guide the work. Usually, the catheter
is left in place to drain the pericardial space for a few days to help prevent
future fluid buildup. The catheter is taken out when all the fluid has drained
and isn't re-accumulating.
·
Open-heart surgery. If
there's bleeding into the pericardium, especially due to recent heart surgery
or other complicating factors, open-heart surgery may be done to drain the
pericardium and repair any damage. Sometimes, a surgeon may create a passageway
that allows fluid to drain as needed into the abdominal cavity, where it can be
absorbed.
·
Removal of the pericardium (pericardiectomy). If
pericardial effusions continue to occur despite drainage procedures, a surgeon
may recommend removing all or part of the pericardium.
Preparing
for your appointment
If your pericardial effusion is
discovered as a result of a heart attack or another emergency, you won't have
time to prepare for your appointment. Otherwise, you'll likely start by seeing
your primary care provider. You might be referred to a doctor who specializes
in heart diseases (cardiologist).
What you can do
When you
make the appointment, ask if there's anything you need to do in advance, such
as fasting before a specific test. Make a list of:
·
Your symptoms, including
any that seem unrelated to your heart or breathing
·
Key personal information, including
major stresses, recent life changes and medical history
·
All medications, vitamins
or supplements you take, including doses
·
Questions to ask your
health care provider
Take a
family member or friend along, if possible, to help you remember the
information you receive.
For pericardial effusion, some
basic questions to ask your doctor include:
·
What's likely causing my symptoms?
·
What tests do I need?
·
Should I see a specialist?
·
How severe is my condition?
·
What's the best course of action?
·
I have other health conditions. How can I best manage these
conditions together?
·
Are there brochures or other printed material I can have? What
websites do you recommend?
What to expect
from your doctor
Your health care provider is
likely to ask you a number of questions, including:
·
When did symptoms begin?
·
Do you always have symptoms or do they come and go?
·
What, if anything, seems to improve your symptoms? For example,
is your chest pain less severe when you sit and lean forward?
·
What, if anything, appears to worsen your symptoms? For example,
are your symptoms worse when you're active or lying down?
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