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Pericardial Effusion

Definition


Disease: Pericardial Effusion Pericardial Effusion
Category: Cardiovascular diseases
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Disease Definition:

The heart is surrounded by a double-layered sac-like structure known as the pericardium. The space between the layers naturally contains a very small amount of fluid. Pericardial effusion is the accumulation of extra fluid around the heart. This condition is usually associated with inflammation of the pericardium due to a disease or injury, but it could also occur when there isn’t any inflammation. Additionally, this effusion could be caused by blood accumulation after a surgical operation or injury.


When left untreated, this condition could result in heart failure or death. When the volume of fluid passes the pericardium’s “full” level, pericardial effusion adds pressure on the heart, resulting in poor heart function.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Some of the symptoms that pericardial effusion may cause are:

 

 

  • Cough
  • Fainting or dizziness
  • Rapid heart rate
  • Shortness of breath when lying down (orthopnea)
  • Shortness of breath or difficulty breathing (dyspnea)
  • Low-grade fever
  • Chest pain, often behind the breastbone or on the left side of the chest.
  • Overall sense of fatigue or weakness
  • Painful breathing, particularly when inhaling or lying down



Having significant pericardial effusion doesn’t necessarily cause signs or symptoms, especially when the fluid has increased slowly. This is more common when the cause of pericardial effusion is cancer or a chronic inflammatory disorder, like rheumatoid arthritis.

Emergency medical care should be sought when:

 

  • Breathing is difficult or painful
  • Having an unexplained fainting spell
  • Experiencing chest pain that lingers for more than a few minutes


A doctor should be called when someone experiences shortness of breath, fatigue or other symptoms of pericardial effusion, in addition to the above mentioned emergency signs.

Causes:

A reaction to injury, disease or an inflammatory disorder affecting the pericardium can cause inflammation of the pericardium (pericarditis). Pericardial effusion is usually one component of this inflammatory reaction. This effusion might also occur when the flow of pericardial fluids is blocked or when blood is accumulated within the pericardium. How some diseases lead to pericardial effusion is uncertain, and the cause is not determined in some cases.

Pericardial effusion has particular causes, such as:

 

  • Autoimmune disorders like lupus or rheumatoid arthritis
  • Viral, fungal, parasitic or bacterial infections
  • HIV/AIDS
  • Spread of cancer (metastasis), especially breast and lung cancer, leukemia, non-Hodgkin’s lymphoma or Hodgkin’s disease.
  •  Hypothyroidism
  • Inflammation of the pericardium following heart surgery or a heart attack (Dressler’s syndrome)
  • Waste product in the blood caused by kidney failure (uremia)
  • Inflammation of the pericardium caused by unknown factors (idiopathic pericarditis)
  • Trauma or puncture wound close to the heart
  • Radiation therapy for cancer if the heart is within the field of radiation
  • Some prescription medications, such as hydralazine, a medication for high blood pressure; isoniazid, a tuberculosis medication; and phenytoin, a medication for epileptic seizures.
  • Chemotherapy treatment for cancer, like doxorubicin and cyclophosphamide.
  • Cancer of the pericardium or heart

Complications

Complications:

Without causing any complications, the pericardium can only hold a limited amount of excess fluid. A single layer of cells that sticks to the heart makes up the inner layer of the pericardium, while a thicker and only somewhat elastic layer is found on the outside. The pericardium will expand inward or toward the heart when the amount of liquid reaches a certain level.

The pumping chambers of the heart will fail to fill completely, and one or more chambers may partially collapse in case pericardial effusion puts pressure on the heart. Poor blood circulation and an inadequate supply of oxygen in the body will be the result of this condition called tamponade. If left untreated, this condition can be life-threatening.

Treatments:

Depending on the following factors, treatment for pericardial effusion can be determined:  

 

  • How has the fluid accumulated
  • The underlying reason for the effusion
  • Whether impaired heart function due to pressure on the heart known as tamponade, might be or is the outcome of pericardial effusion



Anti-inflammatory medications:
When a person has  neither tamponade nor an immediate risk of having one, one of the following medications might be prescribed to treat inflammation of the pericardium that might be contributing to pericardial effusion:

 

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or indomethacin
  • Colchicine
  • Aspirin

 

Corticosteroids like prednisone might be prescribed when having a recurring pericardial effusion after a successful treatment, or when medications aren’t beneficial or helpful.



INVASIVE PROCEDURES:
The below mentioned procedures might be recommended by a cardiologist to drain fluids or stop fluids from re-accumulating in the case of having tamponade, having an increased risk of tamponade or when anti-inflammatory treatments are not sufficient to correct the problem.

Pericardiocentesis:
A needle is used in this operation to enter the pericardial space and then a small tube (catheter) is inserted to drain the fluid from the pericardium. Imaging devices, either echocardiography or a type of X-ray technology known as fluoroscopy will be used to guide the work. ECG machine is used to monitor the heart throughout the operation. In order to help stop fluids from accumulating again, in most cases the catheter would be left in position for a few days to drain the pericardial space.

Open heart surgery:   
Undergoing surgery to drain the pericardium and repair any associated damage might be required when a recent heart surgery or other complicating factors result in bleeding into the pericardium. Sometimes, a surgeon might drain the pericardium and create a “passage” and leave it to drain as it should into the abdominal cavity where the fluid can be absorbed.

Intrapericardial sclerosis:
The surgeon injects a solution in this procedure into the space between the two layers of the pericardium that basically seals the layers together. This method is often used in the case of a recurring pericardial effusion or when cancer is the cause of the effusion.

Pericardiectomy:  
A rarely performed procedure often reserved for treating recurring pericardial effusion despite catheter drainage, all or a portion of the pericardium is surgically removed in this method. Without the pericardium, the heart could function adequately.

Prognosis:

Not available

Expert's opinion

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