What Is Pericardial Effusion?

Pericardial effusion is an abnormal buildup of fluid in the membranous sac surrounding the heart, called the pericardium. Excess pericardial fluid puts pressure on the heart, reducing its ability to pump blood and oxygenate the body. Minor fluid buildups, called trivial pericardial effusion, are often asymptomatic – without perceived symptoms – and can be accommodated by the heart. More severe cases pose a serious health risk and require medical and sometimes surgical treatment.

Symptoms

The pericardium is like a loose-fitting sleeve for your heart. It normally contains a small amount of fluid, about two to three tablespoons’ worth, which creates a favorable environment for cardiac muscle contractions. If, however, the pericardium becomes irritated or inflamed, it fills with additional fluid that presses in on the heart, hampering its operation. Most persons with pericardial effusion tend to develop symptoms only after a large amount of fluid has accumulated around the heart. Pericardial effusion symptoms, also called fluid around the heart symptoms, include:

• Chest pain originating behind or to the left of the breastbone
• Tightness in the chest
• Lightheadedness
• Shortness of breath
• Labored breathing while resting on your back
• Difficulty swallowing
• Fatigue
• Stomach upset
• Swelling in the legs or abdomen

A small pericardial effusion can build slowly over time without any obvious symptoms. Symptoms of a more serious condition known as cardiac tamponade include shock and bluing lips and skin. Cardiac tamponade is life-threatening and calls for an emergency medical intervention.

Causes

Pericardial effusions have a variety of potential causes, often in conjunction with an inflammatory condition known as pericarditis. (Minor fluid buildups, sometimes called trace pericardial effusion, may result from inflammation rather than any specific disease.) Pericardial effusion causes include:

• Viral, bacterial, or fungal infections of the pericardium
• Traumatic injury to the chest
• Autoimmune disorders, such as lupus or rheumatoid arthritis
• Metastasizing cancers
• Radiation or chemotherapy for cancer
• Uremia (kidney failure)
• Thyroid imbalances
• Certain prescription medications

Physicians are not always successful in determining the reason for pericardial effusion. Such cases are described as idiopathic, meaning the condition is real but the cause is unknown.

Diagnosis

There are several steps your physician can take to diagnose pericardial effusion. These include:

• Documentation of fluid around heart symptoms: Your physician will ask about your chest pain and other symptoms – their nature, location, and duration. He or she will also want to know if you or members of your family have a history of heart disease or any other health condition that’s been linked to pericardial effusion.
• Physical exam: Your physician will perform a physical exam, which will include listening to your heart with a stethoscope. You may also undergo one or more diagnostic tests looking for evidence of infection, inflammation, or fluid pooling in the region around the heart.

If there is reason to suspect an underlying medical issue involving your heart, your physician may order:

• An echocardiogram: An echocardiogram uses ultrasound technology to provide a visual record of your heart’s structure and operation. Echocardiograms can detect fluid buildup in the pericardium.
• An electrocardiogram (EKG or ECG): EKGs measure your heart’s electrical activity, which can provide evidence for serious medical conditions, such as cardiac tamponade.
• A chest X-ray: By showing the heart in silhouette, an X-ray can reveal an enlarged pericardium.

Treatment

Pericardial effusion treatment is based on the cause and extent of fluid accumulation. When buildup is minimal, treatment emphasizes pain and swelling reduction. When buildup is extensive, hospitalization and surgery may be required.

Pain Relief

The following drugs have proven useful in pericardial effusion treatment:

• Pain Relievers: Both over-the-counter pain relievers, such as aspirin or ibuprofen, and prescription medications can reduce swelling and lessen pain in persons suffering from pericardial effusion.
• Corticosteroids: Steroid medications, such as prednisone, have also been effective in controlling pericardial symptoms.
• Colchicine: Physicians sometimes prescribe the anti-inflammatory medication, colchicine, for severe pericardial pain.

Surgical Procedures

The riskiest complication of pericardial effusion is cardiac tamponade. Treating this condition, which is life-threatening, typically requires hospitalization and surgery:

• Pericardiectomy: This procedure relieves pressure on the heart caused by an engorged pericardium. The surgeon removes the defective pericardium, allowing the heart to pump freely again.
• Pericardiocentesis: Pericardiocentesis involves the insertion of a catheter into the pericardium to drain away excess fluid. The catheter may remain in place for several days before the process is completed.
• Balloon pericardiotomy: In this procedure, a small balloon is inflated between the layers of the pericardium and fluid is drained through the tube.
• Open heart surgery: A physician will perform open heart surgery if there is bleeding in the pericardium, which can be another source of inflammation and fluid accumulation. This sometimes includes opening a passageway into the abdominal cavity, where the excess pericardial fluids can be reabsorbed by the body.