Pericardial effusion

Pericardial effusion (per-e-KAHR-dee-ul uh-FU-zhun) is the buildup of too much fluid in the sac around the heart. The sac is called the pericardium. It has two layers.

The space between these layers often has a thin layer of fluid. But if the pericardium is diseased or injured, too much fluid can collect in the area. Bleeding also can cause fluid to build up around the heart. Bleeding may occur after a chest injury or be due to cancer.

Pericardial effusion can put pressure on the heart, affecting how the heart works. If the condition is not treated, it may lead to heart failure or death.

You might not notice any symptoms at first. This is especially true if the fluid has increased slowly.

If pericardial effusion symptoms do occur, they might include:

• Shortness of breath or difficulty breathing.
• Discomfort when breathing while lying down.
• Chest pain, usually behind the breastbone or on the left side of the chest.
• Chest pressure or fullness.
• Lightheadedness or feeling faint.
• Swelling in the legs or belly area.

Call 911 or your local emergency number if you have:

• Chest pain that lasts more than a few minutes.
• Breathing that is difficult or painful.
• Unexplained fainting.

There are many different causes of pericardial effusion. Sometimes the cause is not known.

Health conditions that can cause pericardial effusion include:

• Autoimmune conditions, such as rheumatoid arthritis or lupus.
• Cancer of the heart or the sac around the heart.
• Some infections.
• Spread of cancer, called metastasis. This is especially true with lung cancer, breast cancer or Hodgkin lymphoma.
• Swelling of the sac around the heart after a heart attack or a heart surgery or procedure.
• Underactive thyroid, called hypothyroidism.
• Waste products in the blood due to kidney failure. This is called uremia.

Other things that can cause pericardial effusion are:

• Use of some medicines.
• Exposure to toxins.
• Chest injury.

Radiation therapy for cancer if it's near the heart.

A potential complication of pericardial effusion is cardiac tamponade (tam-pon-AYD). In this condition, extra fluid in the sac around the heart puts pressure on the heart. (6) The pressure prevents the heart chambers from filling completely with blood.

Cardiac tamponade is a life-threatening condition. It causes poor blood flow and too little oxygen for the body. Emergency medical treatment is needed.

To diagnose pericardial effusion, a healthcare professional examines you and asks questions about your symptoms and medical history. The health professional listens to your heart and lungs with a tool called a stethoscope.

Tests

Tests are done to diagnose or confirm pericardial effusion. They may include:

• Echocardiogram. Sound waves are used to create pictures of the beating heart. An echocardiogram shows the heart chambers and heart valves. It shows how well the heart is pumping blood. It can see how much fluid is between the two layers of the sac around the heart. The test can tell if the heart isn't working well due to cardiac tamponade.
• Electrocardiogram, also called an ECG or EKG. This quick test measures the electrical activity of the heart. It shows how fast or how slow the heart is beating. Sticky patches with sensors on them go on the chest and sometimes the arms and legs. Wires connect the sensors to a computer, which displays or prints results. Certain signal patterns in an ECG may suggest cardiac tamponade.
• Chest X-ray. This test shows the condition of the heart and lungs. It can show the size and shape of the heart. If there is a large pericardial effusion, the heart may look bigger than usual.
• CT and MRI scans. These imaging tests can show pericardial effusion. But they aren't usually done to look for the condition. A pericardial effusion may be seen on CT and MRI scans when the tests are done for other reasons.

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 the complication, you may get medicines to treat pericardial effusion.

Medicines to treat pericardial effusion may include:

• Aspirin.
• Nonsteroidal anti-inflammatory drugs, also called NSAIDs, such as ibuprofen (Advil, Motrin IB, others).
• Colchicine (Colcrys, Mitigare).
• A corticosteroid, such as prednisone.

Surgery or other procedures

You may need treatment to drain a pericardial effusion or prevent future fluid buildup if:

• Medicines don't fix the pericardial effusion.
• A large pericardial effusion causes symptoms and increases the risk of complications.
• You have a complication called cardiac tamponade.

Procedures or surgeries to treat a pericardial effusion include:

• Pericardiocentesis. A doctor places a needle in the sac around the heart. Echocardiogram images help guide the needle to the correct area. The doctor uses a small, flexible tube called a catheter to remove the extra fluid around the heart. Usually, the tube stays in place for a few days. The tube is taken out when all the fluid has drained and isn't building up again.
• Open-heart surgery. If you have bleeding into the sac around your heart, open-heart surgery may be needed to drain the fluid and fix any damage. Sometimes, a surgeon creates a pathway from the heart to the space between the stomach wall and the spine. This space is called the abdominal cavity. The pathway lets the fluid drain as needed.
• Removal of the sac around the heart, called a pericardiectomy. This surgery removes all or part of the sac around the heart. It's done if a pericardial effusion keeps coming back after being drained.

If a pericardial effusion is found after a heart attack or other emergency, you won't have time to prepare for an appointment. You might be sent to a doctor trained in heart diseases. This type of doctor is called a cardiologist.

What you can do

When you make the appointment, ask if there's anything you need to do in advance. For example, you may be told not to eat or drink before some tests.

Make a list of:

• Your symptoms, including any that seem unrelated to your heart or breathing.
• Important personal information, including major stresses, recent life changes and medical history.
• All medicines, vitamins or supplements you take. Include the dosages.
• Questions to ask your healthcare team.

If possible, take someone with you to help you remember the information you receive.

For pericardial effusion, some basic questions to ask your healthcare team are:

• What's the likely cause of my symptoms?
• What tests do I need?
• Should I see a specialist?
• How severe is my condition?
• What's the best treatment?
• I have other health conditions. How can I best manage these conditions together?
• Is there any information that I can take home with me? What websites do you recommend?

What to expect from your doctor

Your healthcare team will likely ask many questions, including:

• When did your symptoms start?
• Do you always have symptoms or do they come and go?
• What, if anything, seems to make the symptoms better? For example, is your chest pain any better when you sit and lean forward?
• What, if anything, appears to make the symptoms worse? For example, are your symptoms worse when you're active or lying down?