Pericardial effusion is a condition in which too much fluid builds up in the pericardial space surrounding the heart. The heart is surrounded by a double-layered membrane called the pericardial membrane. This creates a pericardial sac around the heart containing pericardial fluid. This fluid acts as a lubricant to reduce friction when the heart beats.
The fluid can build up in this space due to possible inflammatory or non-inflammatory causes which will exert increased pressure on the heart.
This will create resistance when the heart beats against the increased pressure. Untreated pericardial effusion can have consequences: poor heart function, heart failure or even death.
Symptoms Of Pericardial Effusion
The intensity and onset of symptoms depends on the speed with which fluid accumulates around the heart. You may have a significant volume of pericardial effusion fluid and yet no symptoms if the accumulation occurred very slowly.
These symptoms which may signify you are suffering from pericardial effusion. These include:
- Shortness of breath (or dyspnea)
- Difficulty breathing in a lying down position (orthopnea)
- Chest pain: This pain is usually located right behind the sternum and is aggravated on breathing in and in a lying down position. The pain is relieved with the patient sitting up.
- Low grade fever
- Rapid heart rate
The shortness of breath is experienced because the heart cannot pump blood out with full force into the circulation. The pressure from the outside causes the blood to pool back and accumulate in the lungs which causes the symptoms of orthopnea and dyspnea.
Dangerous Symptoms To Look For
There are some danger signs you should look for, and contact a doctor immediately if you experience any one of these. These include:
- Chest pain lasting more than a few minutes
- Difficult breathing or painful respiration
- Unexplained spells of fainting
What Causes Pericardial Effusion?
The primary cause is inflammation of the pericardium called Pericarditis which causes the overproduction of inflammatory fluid accumulating in the pericardial sac. Pericarditis can be caused by disease, injury or an inflammatory disorder.
Pericardial effusion is a sign indicating the presence of an inflammatory response in the pericardium.
Click here to read about pericarditis symptoms
Effusion can be caused if the outflow of fluid is blocked. Another important condition that can lead to effusion is blood accumulating in the pericardial sac, leading to a blood filled effusion.
Specific causes which may lead to Pericardial effusion, these include:
- Infection: Many bacterial, viral or parasitic infections may cause pericardial effusion formation.
- Idiopathic: When the cause of the effusion is unknown, we call it idiopathic effusion
- Dressler’s syndrome: This is a type specifically occurs after some heart surgery or a myocardial infarction. This causes inflammation of the pericardial membrane, which eventually leads to effusion.
- Autoimmune: Pericardial effusion can also be a result of the body’s immune system attacking the antigens on the pericardial membrane. This will also lead to inflammation and effusion formation. Many autoimmune conditions can cause it namely lupus, rheumatoid arthritis or lupus.
- Uremia: This is caused by elevated amount of waste products in the body like urea and creatinine. These waste products can be raised in the blood in chronic renal failure. These waste products attack the heart membranes and cause pericardial effusion.
- Hypothyroidism: With low thyroid hormone levels in the blood, pericardial effusion may develop.
- Metastasis: Spread and seeding of cancer cells throughout the body can attack the pericardium, leading to the formation of pericardial effusion. This is particularly important in cancers such as lung cancer, breast cancer, non-Hodgkin’s lymphoma or Hodgkin’s disease.
- Tumor: A direct cancer of the heart or the pericardium can also cause effusion.
- Radiation therapy for cancer: This may lead to the formation of an effusion if the heart was within the confines of the radiation field.
- Chemotherapy: Chemo for cancer can produce similar effects. Doxorubicin and cyclophosphamide are two known agents that can lead to the formation of a pericardial effusion.
- Trauma or puncture wounds: Injury around the heart can lead to effusion in the area of the damage as inflammatory cells pour in.
- Drugs: There are many drugs which may produce pericardial effusion as a side effect. These include hydralazine (used to manage high blood pressure), isoniazid (a drug used in the treatment of tuberculosis) and phenytoin (a drug used for the treatment of epileptic seizures).
Complications Of Pericardial Effusion
The pericardial space can hold a limited amount of fluid before symptoms appear. The anatomy of the pericardial sac is such that the inner layer of the membrane is tightly adhered to the surface of the heart and can’t be peeled off.
The outer layer is more elastic and mobile. When fluid accumulates in this small space, the pericardium will expand inwards towards the heart. The heart will face difficulty in completely filling. The pumping chambers can do limited work against this pressure from the outside.
Over time, prolonged excessive pressure can causes one or more of the heart chambers to partially collapse. This condition is known as cardiac tamponade. Cardiac tamponade causes poor blood circulation and inadequate supply of oxygen to the body. This may be a life threatening condition if left untreated.
What Tests Diagnose Pericardial Effusion?
- Your doctor will perform a medical exam by listening to your heart beat with the help of a stethoscope. A case of Pericarditis will give a scratching sound on auscultation. The accumulation of large amounts of fluid will result in muffled heart sounds.
- An echocardiogram of the heart will show a decreased heart function due to the pressure on the heart caused by the cardiac tamponade. This test is performed by your cardiologist to reveal to what extent the chambers of your heart are collapsed.
- An ECG or an EKG will also reveal the extent of damage on the heart.
- A chest Xray can also be performed. A pericardial effusion will result in an enlarged silhouette if the amount of fluid due to pericardial effusion is large.
Closing Thoughts On Pericardial Effusion
Pericardial effusions that occur for at least 3 months or more are called chronic pericardial effusions. Very often, there seems to be no direct cause which can be identified. Chronic effusions are often monitored without needing treatment. It’s only if they begin to cause the patient symptoms, or impairent of the heart, that drainage is usually necessary.
Many pericardial effusions may also be caused by particular medical conditions.In these specific cases where there is an underlying disease, treating the underlying medical condition will often help treat the pericardial effusion.