Pericardial Effusion: Causes, Symptoms, and Treatment (2022)

The heart has a sac around it called the pericardium. The purpose of this sac is to protect the heart from the structures that surround it. Inside the sac there is normally a small amount of fluid evenly spread in a thin layer around the whole heart. This fluid around the heart is known as pericardial fluid and basically acts as a lubricant to allow the heart to pump and turn with minimal friction. I’ll use the terms fluid around the heart and pericardial effusion interchangeably throughout this article so you become familiar with the terms.

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Pericardial Effusion: Causes, Symptoms, and Treatment (1)

How does Excess Fluid Around the Heart Develop?

There is normally a small amount of fluid around the heart (small pericardial effusion). This is produced by the sac around the heart and is an important part of normal heart functioning. Excess fluid around the heart is known as a pericardial effusion. But where does this excess fluid come from? Often, when the heart experiences inflammation (known as pericarditis) extra fluid releases and collects within the sac. It is also possible for blood to fill the sac during or after trauma, surgery, or complications of other heart procedures. Blood around the heart is known as hemopericardium. The fluid around the heart is usually continually produced and drained, so the level stays constant. Sometimes in patients with heart failure,high pressures within the heart cause the fluid not to drain properly. The body, however, continues to produce pericardial fluid, leading to excess fluid around the heart (chylous pericardial effusion).

(Video) Pericarditis and pericardial effusions - causes, symptoms, diagnosis, treatment, pathology

Causes of Pericardial Effusion

The most common cause of pericardial effusion is inflammation of the lining around the heart. In most cases, the exact caused is never found. In other cases an autoimmune reaction – where the body attacks its own cells – is the culprit. This is primarily seen in conditions like lupus and rheumatoid. Some drugs have also been associated with the development of pericardial effusion.Another caused of excess fluid around the heart is kidney disease (uremic pericardial effusion). Finally, it is relatively common to see small amounts of excess pericardial fluid during pregnancy.

A bloody pericardial effusion is typically a more urgent issue and is seen as a result of blood leaking from inside the heart, or from the large vessels that leave the heart. Causes may include heart muscle tearing during a heart attack or a tearing of the great vessels leaving the heart (an aortic dissection). More rarely, a bloody pericardial effusion can result from the presence of cancer cells in the lining around the heart. In these cases, cancertypically originates elsewhere in the body and invades the heart.

When Does Fluid Around the Heart become a Problem? – Cardiac Tamponade

Imagine the sac around the heart (pericardium) to be like a hot water bottle that’s the shape of a heart that allows for a small amount of fluid to be there acting like a lubricant. If there’s a sudden, significant increase in fluid around the heart, the sac doesn’t expand. Instead, the fluid compresses the heart,as the pressure inside the sac are greater than the pressure inside the heart. This renders the heart incapable of filling with blood, essentially causing a shortage of oxygenated blood. This process is known as cardiac tamponade and can be life threatening.

Cardiac tamponade only occurs if there is a sudden and significant increase in pericardial fluid or if there is a very large amount of fluid collected over time. Interestingly, it can be more dangerous for just 50cc of fluid to collect rapidly, than for 1 liter of fluid to collect over time. Why is this? When there is a slower accumulation of pericardial fluid over time, the sac around the heart slowly enlarges to accommodate the fluid – something it cannot do if there is a sudden increase. Effusions involving blood are often emergencies, because the blood may leak into the sac at high pressure.

Pericardial Effusion: Causes, Symptoms, and Treatment (2)

(Video) Cardiac Tamponade - pericardial effusion, causes, pathophysiology, investigations and treatment

When I drain these effusions, sometimes patients are surprised that such a small amount of fluid could cause such a big problem. Other patients are amazed such a large amount of fluid (often liters) wasn’t causing noticeable problems.

Detecting FluidAround the Heart – DiagnosticTesting for a Pericardial Effusion

The main way to assess a pericardial effusion is an ultrasound scan of the heart known as an echocardiogram. The echo helpsquantify the amount of fluid around the heart, tells us how the heart is handling the excess fluid, and determines what action must be taken. Sometimes features on the echocardiogram help us determine the fluid type, i.e. blood vs. other. Pericardial effusions are also commonly picked up on CT scans. CT scans are useful for determining the amount of fluid around the heart; however,echocardiograms are more effective for understandinghow the pericardial effusion is affecting the heart.

Pericardial Effusion: Causes, Symptoms, and Treatment (3)

I have fluid around my heart, what should I do? – Management of a pericardial effusion

Treatment & Management

The treatment for pericardial effusion depends upon the amount of fluid surrounding the heart. Generally, patients with pericardial effusion are broken into three groups; mild, moderate, or large (cardiac tamponade).

Mild Pericardial Effusion

Unless it has occurred rapidly and led to unstable symptoms, mild pericardial effusion is usually found by chance on scans performed for other purposes. Typically a mild effusion will require no specific treatment for the effusion itself. Instead, the underlying cause is treated. The presence of an effusion may alert the physician to perform various tests to identify a cause and rule out more serious causes. For example, if the effusion is attributed to lupus, the effusion will probably resolve with treatment of lupus. The same may apply to any cause. Typically a follow-up scan is performed to ensure the effusion has resolved. Sometimes the fluid is drained and sent for analysis.

(Video) Pericarditis: Symptoms, Pathophysiology, Causes, Diagnosis and Treatments, Animation

Moderate Pericardial Effusion

The management of a moderate pericardial effusiondepends on the individual case, its effect on heart function, and the presence of symptoms. In some cases, especially when the underlying cause is known and there is no significant effect on the heart function, the effusion may just be monitored over time with echocardiograms. If the effusion persists, grows larger over time, or causes symptoms it may need to be drained. The cardiologist in charge of the case will typically make this decision.

Large Pericardial Effusion or Cardiac Tamponade

Large effusions will typically be drained. After the excess fluid around the heart has been drained, a drain may be temporarily left in place to ensure further fluid does not accumulate. In some cases, particularly when effusions recur, a hole is made in the sac to allow continuous drainage.

Symptoms

By its self, the presence of fluid around the heart doesn’t cause symptoms. Instead, symptoms occur when excess pressure in the heart sac prevents proper functioning of the heart. In severe cases, this can cause a state of shock. Usually, symptoms only occur if the accumulation of fluid is rapid or if the amount is very large. Symptoms of a significant effusion may include:

  • Dizziness
  • Light headaches
  • Fatigue
  • Shortness of breath
  • Passing out or fainting
  • Palpitations

Effusions themselves don’t cause chest pain; however, effusions associated with pericarditis – inflammation of the sac around the heart – may be associated with chest pain.

Draining Fluid Around the Heart: Pericardiocentesis, Pericardial Drain, Pericardial Window

When do we drain the fluid around the heart?

(Video) Pericarditis and Pericardial Effusion

In general there are two indications to drain pericardial effusions. First, doctors remove the fluid if it is affecting heart function. Second, doctors will drain fluid around the heart to test the pericardial fluid in a lab and determine the effusions’s cause.

How do we drain fluid around the heart?

There are 2 main ways to do drain pericardial fluid. The first is a minimally invasive procedure – known as a pericardiocentesis – that involves passing a small tube through the skin into the lining around the heart. The fluid is drained through the tube, and a drain can be left in if required. The second is a surgical procedure that involves making a small incision underneath the breastbone. As in a pericardiocentesis, a tube is used to access the pericardial fluid, often making a small hole in the lining of the pericardial sac known as a pericardial window. The window will generally stay open over time, allowing constant drainage of the fluidto prevent accumulation.

The less invasive pericardiocentesis procedure is usually tried first. Often the drain is left for up to a few days to see if the fluid builds back up. If the fluid continues to accumulate, a pericardial window procedure can be considered. Sometimes an immediate surgical approach is required, particularly in emergencies when a bloody effusion is caused by a rupture of the heart or the great vessels itself.

What questions should I ask my doctor?

(Video) PERICARDIAL EFFUSION vs CARDIAC TAMPONADE - EXPLAINED IN 5 MINUTES (Beck's Triad, Causes, Diagnosis)

Once someone is found to have a pericardial effusion, they will be referred to a cardiologist who will evaluate them and make treatment decisions. Questions to ask include:

  • How big is the effusion and is it affecting the function of the heart?
  • What is the cause of the effusion?
  • If the effusion is felt large or significant enough to be drained, what is the way in which this will be done, and what is the plan if it should come back?
  • Finally, what is the long-term treatment plan?

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FAQs

What is the cause of pericardial effusion? ›

Pericardial effusion can happen after heart surgery, radiation therapy for cancer or as a side effect of some medications. Other. Pericardial effusion can also happen with heart failure, chronic kidney disease or kidney failure, liver cirrhosis or for unknown reasons.

What is the treatment for pericardial effusion? ›

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.

Can a small pericardial effusion cause symptoms? ›

Because these often cause no symptoms, they're frequently discovered after the results of routine tests are abnormal. These tests can include: Physical examination: A doctor may hear abnormal sounds over the heart that can suggest inflammation. However, pericardial effusions usually can't be found through a physical.

What is the best treatment for pericarditis? ›

Treatment
  • Pain relievers. Pericarditis pain can usually be treated with over-the-counter pain relievers, such as aspirin or ibuprofen (Advil, Motrin IB, others). ...
  • Colchicine (Colcrys, Mitigare). This drug reduces inflammation in the body. ...
  • Corticosteroids. Corticosteroids are strong medications that fight inflammation.
Apr 30, 2022

How long is recovery from pericardial effusion? ›

Recovery may take several weeks or months, depending on the severity and cause of the pericardial effusion. A possible complication of pericardial effusion is cardiac tamponade, which is a medical emergency requiring immediate intervention.

What medications cause pericardial effusion? ›

Causes of Pericardial Effusion

Certain prescription drugs, such as hydralazine, a medication for high blood pressure; isoniazid, a tuberculosis drug; and phenytoin, a medication for epileptic seizures. Chemotherapy drugs, such as doxorubicin and cyclophosphamide.

Is pericardial effusion normal? ›

There is normally a small amount of fluid around the heart (small pericardial effusion). This is produced by the sac around the heart and is an important part of normal heart functioning. Excess fluid around the heart is known as a pericardial effusion.

What drugs cause pericarditis? ›

Pericarditis can also develop from a drug-induced lupus syndrome caused by medications including procainamide, hydralazine, methyldopa, isoniazid, mesalazine, and reserpine. Methysergide causes constrictive pericarditis through mediastinal fibrosis.

What doctor treats pericardial effusion? ›

Treatment for Pericardial Effusion

As an interventional cardiologist, Dr. Jobe performs a nonsurgical, catheter-based procedure called pericardiocentesis to treat pericardial effusion. During pericardiocentesis, a doctor threads a catheter into the sac surrounding the heart to drain built-up fluid and relieve symptoms.

Can a pericardial disease be cured? ›

Depending on the severity of the buildup, pericardial effusion may be treatable with medicines. If the health care team determines that it's necessary to drain the excess fluid, they may recommend a procedure called pericardiocentesis, which uses a needle and small catheter to drain the fluid.

Will pericardial effusion disappear? ›

How is it treated? If there is only a small amount of extra fluid in your pericardium, you may not need treatment. The extra fluid may go away on its own. Treatment depends on the cause of the extra fluid, the amount of fluid, and your symptoms.

How long can you live with pericardial effusion? ›

Survival rates are consistently poor in patients with malignancy who present with a pericardial effusion. In our series, patients had a median survival of 2.6 months. Patients with lung cancer had a median survival of 2.1 months while those with other types of cancer of 4.7 months.

How long does pericardial effusion pain last? ›

The condition usually clears up after three months, but sometimes attacks can come and go for years. Sometimes there is extra fluid in the space between the pericardial layers, which is called pericardial effusion.

Can you exercise with pericardial effusion? ›

Current guidelines recommend that return to physical exercise or sport is permissible if there is no longer evidence of active disease. This includes the absence of fever, absence of pericardial effusion, and normalization of inflammatory markers (ESR and or C-reactive protein).

Does pericarditis damage the heart? ›

Prognosis of Pericarditis

When treated promptly, most people recover from acute pericarditis in two weeks to three months. It usually leaves no lasting damage to the heart or pericardium.

What home remedy helps pericarditis? ›

Although there are no nutritional supplements that specifically treat pericarditis, the following nutritional supplements may strengthen your immune system and your heart health:
  • Coenzyme Q10 (C0Q10). ...
  • Vitamin E and vitamin C. ...
  • Magnesium. ...
  • Bromelain. ...
  • Fish oil helps lower inflammation over time.
Apr 27, 2016

How long do pericarditis symptoms last? ›

Incessant pericarditis lasts about four to six weeks but less than three months. The symptoms are continuous. Chronic constrictive pericarditis usually develops slowly and lasts longer than three months.

How long can you live with pericardial effusion? ›

Survival rates are consistently poor in patients with malignancy who present with a pericardial effusion. In our series, patients had a median survival of 2.6 months. Patients with lung cancer had a median survival of 2.1 months while those with other types of cancer of 4.7 months.

Is pericardial effusion curable? ›

Depending on the severity of the buildup, pericardial effusion may be treatable with medicines. If the health care team determines that it's necessary to drain the excess fluid, they may recommend a procedure called pericardiocentesis, which uses a needle and small catheter to drain the fluid.

Can fluid around the heart go away on its own? ›

How is it treated? If there is only a small amount of extra fluid in your pericardium, you may not need treatment. The extra fluid may go away on its own. Treatment depends on the cause of the extra fluid, the amount of fluid, and your symptoms.

Pericardial effusion is a buildup of fluid in the space around your heart. When it happens quickly or with a large volume of fluid, it can turn into cardiac tamponade, a dangerous condition.

It can happen for a wide range of reasons, including infections, injuries or other medical conditions.. Under normal circumstances, the pericardium has just enough fluid to cushion your heart, but not so much fluid that your heart can’t expand and fill up with blood with every heartbeat.. Cardiac tamponade happens when there’s too much fluid inside the pericardium, which means your heart has no room to expand and fill up with blood.. As the pericardium fills up, there's less space for your heart to expand.. Possible causes of pericardial effusion include:. Pericardial effusion can happen after heart surgery, radiation therapy for cancer or as a side effect of some medications.. Pericardial effusion is usually a significant condition, but it isn’t always a medical emergency.. When it happens because of injuries or heart and circulatory problems (or any reason that can cause an effusion to develop quickly), pericardial effusion needs quick treatment to avoid dangerous complications like cardiac tamponade.. If you don’t have symptoms, the most likely way a doctor will diagnose pericardial effusion is if they happen to see it on medical imaging for another reason.. The possible tests include:. In some cases, tests on the fluid taken out of your pericardium are also possible.. When a pericardial effusion is large or causes cardiac tamponade, it becomes a medical emergency that needs immediate treatment.. The cause of the effusion.. If you have an effusion that’s growing more quickly, that’s causing symptoms, or that’s happening because of more serious conditions (especially trauma or cancer), you will probably need treatment sooner rather than later.. Pericardial effusion is a condition that can happen to people at any stage in life and for many different reasons.

A pericardial effusion is a buildup of fluid between the tissue surrounding the heart. Pericardial effusion is a symptom of pericardial mesothelioma and other conditions.

Even if doctors cannot determine the cause of the pericardial effusion, they can still provide patients with a treatment plan.. Connection to Mesothelioma Pericardial effusion is a common symptom of malignant pericardial mesothelioma.. Signs & Symptoms Some patients may not present with any symptoms of pericardial effusion.. Pericardial effusion symptoms may vary based on the underlying cause of effusion.. Patients with severe pericardial effusions may experience other symptoms.. Pericardial Effusion Diagnosis To diagnose pericardial effusion, doctors will perform a physical exam and listen to a patient’s heart.. If a patient exhibits any pericardial effusion symptoms, doctors will perform additional testing to confirm the diagnosis.. If a patient is experiencing little to no symptoms, pericardial effusion may be diagnosed accidentally.. If pericardial effusion is diagnosed, doctors may perform additional testing to determine the cause of the effusion.. For patients whose pericardial effusion is caused by mesothelioma, doctors will need to take a biopsy to definitively diagnose the cancer.. Common Treatments There are treatments available for individuals diagnosed with pericardial effusion.

Pericardial effusion causes, symptoms, diagnosis, prognosis, treatment. Find out the difference between pericardial effusion vs cardiac tamponade.

Pericardial effusion. Cardiac tamponade (clinical tamponade) is the most severe manifestation of hemodynamic compromise caused by a tense pericardial effusion (Figure ​5).. What causes fluid around the heart. Causes of pericardial effusion. An echocardiogram can also show decreased heart function due to pressure on the heart (cardiac tamponade).. If anti-inflammatory treatments don’t correct the problem, if you have a large collection of fluid causing symptoms and making you more prone to tamponade, or if you have tamponade, your cardiologist will likely recommend one of the following procedures to drain fluids or prevent fluids from accumulating again.. In a study , which included 71 patients with large pericardial effusion without clinical tamponade, scientists found that pericardial drainage procedures (performed in 26 patients) had a diagnostic yield of only 7%.

A pericardial effusion consists of an excessive presence of fluid collected around the heart , more precisely between the heart wall and the pericardium, the membrane that surrounds the organ.The potential causes of effusion are numerous and are often linked to lesions or inflammation suffered by the pericardium, a hemorrhage caused by the presence of a tumor, or thoracic trauma. The risk of the condition is consequent to the pressure exerted on the heart, which can interfere with proper functioning and in severe cases even become fatal.

A pericardial effusion consists of an excessive presence of fluid collected around the heart , more precisely between the heart wall and the pericardium, the membrane that surrounds the organ.. The potential causes of effusion are numerous and are often linked to lesions or inflammation suffered by the pericardium, a hemorrhage caused by the presence of a tumor, or thoracic trauma.. The pericardial effusion, as well as the possible inflammation of the pericardium that derives from it ( pericarditis ), recognize numerous possible causes, but the most common are:. Infections (viral or bacterial), such as tuberculosis Autoimmune disorders, such as lupus, rheumatoid arthritis, and Sjogren’s syndrome.. In light of a large number of possible causes, it should not be surprising that the payment can therefore affect anyone, regardless of age, sex, and other anamnestic factors.. Depending on the duration it is divided into Acute (rapid onset) Chronic (when more than 3 months).. With the progressive increase in the amount of fluid that accumulates around the heart, the possibility of accommodation of the pericardium may disappear, with the result that some pressure begins to be exerted on the surrounding anatomical structures, such as for example. Overall, therefore, the patient who develops a pericardial effusion could complain of: Sense of pressure or real chest pain (usually felt behind the breastbone or on the left side of the chest) Shortness of breath and shortness of breath (difficulties increase in the lying position) Nausea The feeling of abdominal fullness (caused by the compression exerted by the fluid on the surrounding organs) Difficulty swallowing Tachycardia Vertigo and / or feeling faint Accumulation of fluid in the abdomen or legs (due to heart failure).. A very rapid accumulation of fluids around the heart can cause cardiac tamponade, a serious condition caused by the compression exerted on the heart that compromises its normal ability to function and becomes potentially fatal (losing the ability to dilate sufficiently reduces the possibility of an effective filling of the heart chambers).. In this case, the patient may experience symptoms of shock, due to the insufficient blood he is able to pump:. In some patients, the discovery of the effusion may occur randomly, while performing tests required for other causes.. Treatment of pericardial effusion is primarily aimed at the triggering cause and, if necessary, at patient life support: Medicines (especially useful as a first treatment in the absence of immediate risk of tamponade) Anti-inflammatories for the treatment of effusion caused by inflammatory processes (possibly cortisone drugs can also be used for this purpose) Diuretics in the case of heart failure Antibiotics if the accumulation is a consequence of bacterial infection Chemotherapy, radiotherapy, … In the case of cancer disorders Medical procedures aimed at removing excess fluid Pericardiocentesis aimed not at diagnosis but at reducing the pressure exerted Thoracoscopy is a procedure that involves the introduction of an endoscope to view the pericardial cavity using a small camera and, when possible, intervene by extracting part of the liquid Opening of a pericardial window, which allows the passage of fluid towards the pleura (the membrane that surrounds the lungs, whose capacity for reabsorption of liquids is superior) Percutaneous balloon pericardiotomy, a procedure performed by inserting a catheter with a balloon tip which, once inflated, allows the opening of a window in the pericardium, again for drainage purposes.

A pericardial effusion is a collection of fluid between the membranes lining the heart. Learn about the symptoms and treatments in people with cancer.

A pericardial effusion is defined as the buildup of fluid within the pericardium, the layer of tissues that line the heart. If it develops rapidly, however, an acute pericardial effusion often causes life-threatening symptoms and is a medical emergency.. Unfortunately, symptoms of a pericardial effusion can mimic those of the condition that often results in these effusions (such as lung cancer or metastatic breast cancer), delaying the diagnosis.. Autoimmune conditions (such as with rheumatoid arthritis and lupus) Cancers (both those that spread to the pericardium from other regions of the body such as lung cancer, breast cancer, sarcomas, and lymphomas, and those that begin in the pericardium, such as pericardial mesothelioma ) Current or previous radiation therapy to the chest for lung cancer, breast cancer, esophageal cancer, lymphomas, and others Chemotherapy Kidney failure Hypothyroidism (usually when severe) Inflammation (including pericarditis ) Chest surgery (including surgery for heart disease or lung cancer) Heart attacks Medications. Pericardial effusions may occur with any type of cancer, but the most common include lung cancer, breast cancer, and lymphomas.. With lung cancer , pericardial effusions are very common, with many people undergoing radiation therapy for lung cancer developing some degree of an effusion.. Most of the time, however, a pericardial effusion is associated with other areas of cancer metastases (metastatic cancer) and systemic (whole-body) treatments such as chemotherapy, targeted therapy, and/or immunotherapy are the best options.. Better treatment options for metastatic cancer as well as prompt treatment of a developing pericardial effusion are critical to improve survival.. A pericardial effusion may be mild and temporary with conditions such as some viral infections, but can be serious and a poor prognostic sign for people living with cancer.. The treatment and prognosis of cancers, even lung cancer, is improving, and much of what you may have heard or read about metastatic cancer and pericardial effusions may not only be very disheartening, but inaccurate.

Pericardial effusion is the accumulation of fluid within the pericardium surrounding the heart due to bleeding or effusion (for example due to inflammation). In extreme cases, the volume can increase up to two liters.

A pericardial effusion is the accumulation of fluid within the pericardium surrounding the heart.. In other cases, the following symptoms appear:. Depending on the cause, there may be additional symptoms, such as fever in the case of infective pericarditis.. Pericardial tamponade or pericardial embolism is a life-threatening complication and pericardial effusion is one of the most serious heart diseases where there is acute heart failure with sudden drop in blood pressure and shock.. However, in the case of a larger effusion, emergency treatment should be performed by pericardial puncture, in which the effusion is withdrawn through a cannula.. Treatment of a pericardial effusion depends on the amount of fluid drained.. Before the operation, an attempt is generally made to relieve the effusion by puncturing the pericardium and inserting a tube (drainage).. For better results, the underlying disease that caused the effusion must be treated.

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