Pericardial Effusion

Your heart is enclosed in a double-layered sac called the pericardium. The space between the layers has a small amount of fluid to provide cushion and support to the heart. When the quantity of this fluid exceeds the normal range, it is known as pericardial effusion. This can happen as a result of pericardial inflammation, injury, or toxins and can exert pressure on the heart, making it difficult to work properly. If it happens quickly or the amount of the fluid is too large to compress the heart, it is called cardiac tamponade, which is a life-threatening condition. 

Pericardial effusion is a common condition and is found widely. It can occur in various conditions and can happen at any age to anyone. Many conditions can predispose to pericardial effusions;

·         If you are a patient of any chronic inflammatory disease

·         If you have a trauma to the chest

·         If you have a heart condition or chronic kidney disease

·         If there is cancer in your body

·         If you are taking radiation treatment for cancer.

·         If you are a patient with hypothyroidism.

·         If you are a patient with HIV/AIDS. 

A wide range of conditions can cause pericardial effusion, such as:

·         Infections: Pericardium can be infected with several bacteria and viruses, leading to inflammation and fluid accumulation. Common infectious agents include coxsackievirus A and B, hepatitis viruses, HIV, Pneumococci, streptococci, staphylococci, and Mycobacterium Tuberculosis. Some fungi and parasites may also be responsible, for example, Histoplasmosis, coccidioidomycosis, Candida, Protozoal, etc.

·         Cancer: Tumors affecting the heart or some other tumors that have spread from other parts of your body can affect the pericardium and cause effusion

·         Chronic inflammatory conditions: some autoimmune or inflammatory diseases can also cause pericardial effusion, such as; lupus, Sjögren’s syndrome, rheumatoid arthritis, etc.

·         Hormonal disorders: A thyroid gland disorder called hypothyroidism can cause pericardial effusion.

·         Trauma: Blunt injuries to the chest or from knives or bullets can injure the pericardium and cause pericardial effusion.

·         Heart problems: Conditions affecting the heart like heart failure,  heart attacks, or aortic dissection

·         Others: Chronic kidney or liver disease can cause pericardial effusion. It can also result from heart surgery, radiation therapy, certain medications, etc. 

Small or slowly developing pericardial effusions may not cause evident symptoms. However, if it is large or happens quickly, it can result in the following symptoms:

Shortness of breath

Breathing difficulty on lying flat

Feeling faint, vertigo, and collapse

Palpitations

Chest pain or pressure

Fatigue

Irregular heartbeats

Confusion

To diagnose the disorder, your doctor will inquire about the symptoms and the previous medical records. They will examine you, emphasizing the heart, using a stethoscope for hearing the heart sounds and murmurs. The following tests can be used;

·         Blood tests: Various blood tests, like CBC, inflammatory markers (e.g., ESR, CRP), TSH level, Blood cultures, antibodies, ANA, PCR, complement levels, and tests to assess your kidneys, liver, and thyroid function and digoxin levels may be ordered. 

·         Cardiac enzymes: Increased amounts of specific proteins or enzymes found in cardiac muscle may be detected by blood testing. Any person with chest pain and risk factors should be checked for myocardial infection using a blood test for enzymes.

·         X-ray of the chest. A chest X-ray can reveal a bottle-shaped heart due to a very large effusion.

·         Electrocardiogram: Electrical impulses in the heart are recorded during this simple test. Findings specific to pericardial effusion are electrical alternans, sinus tachycardia, and low voltage QRS complexes. Many other cardiac disorders can also be revealed, such as irregular heartbeats and clogged arteries. ECG is sometimes taken when you work out, usually on a bike or treadmill. A stress test is a name for this approach.

·         Echocardiogram: In this test, ultrasound waves create an image of your heart. This test would be suggested by your physician to check for pericardial effusion.

·         Cardiac MRI or CT scans: When the results of the above tests are unclear, these tests can help localize and quantify the effusion.

·         Pericardiocentesis: It is a procedure in which fluid is withdrawn with the help of a needle from the pericardial cavity guided by an echocardiogram. It can be diagnostic as well as therapeutic. The fluid obtained can be set for analysis for blood cells, bacterial stains, malignant cells, etc. it can also provide symptomatic relief. 

Treatment of pericardial effusion varies and depends on the etiology. The medicines and interventions are used according to the underlying cause and include;

·         Anti-inflammatory medicines such as colchicine and NSAIDs include indomethacin, naproxen, ibuprofen, aspirin diclofenac, ketoprofen, etc.

·         Corticosteroids, for example; prednisone, prednisolone, methylprednisolone

·         Antibiotics if the underlying cause is infections such as vancomycin, ciprofloxacin, ceftriaxone, isoniazid, ethambutol, rifampin, pyrazinamide,

·         Hemodynamic support to be given includes IV Fluid administration or a pulmonary artery balloon catheter.

·         Pericardiocentesis: This procedure involves removing fluid from the pericardial cavity to elevate the symptoms.

·         Surgery: Surgical drainage is performed in localized effusions by creating a window in the pericardium that provides a passage for the flow of fluid outside the cavity.

Some other disorders that a patient should be evaluated for include;

·         Myocardial infarction

·         Pulmonary embolism

·         Pneumothorax

·         Acute pericarditis

·         Pneumonia

·         Esophageal rupture

A small effusion that is not progressing or causing any symptoms has a good prognosis. Some people may not need any intervention for such types of effusions. They are just followed up regularly. But a quickly developing or an enlarged effusion causing many symptoms need immediate intervention. Cardiac tamponade is an emergency condition that can result in death if not treated properly on time. Effusions resulting from trauma, sepsis, immunosuppressed states, or cancer have a poor outcome. 

If you have the abovementioned risk factors, you should be cautious if you develop any symptoms of pericardial effusion. Do not try to treat yourself. Always consult your healthcare provider. Moreover, avoid relentless sports or activities that can lead to traumatic effusion. Take care of your health and seek treatment for any infection.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 26, 2023.

References

Definition of pericardial effusion - NCI Dictionary of Cancer Terms - NCI

https://www.cancer.gov/publications/dictionaries/cancer-terms/def/pericardial-effusion

New Approaches to Management of Pericardial Effusions | SpringerLink

https://link.springer.com/article/10.1007/s11886-021-01539-7