Pericardial Effusion: Causes, Symptoms, Diagnosis, Treatment and Complications

The term "pericardial effusion" refers to the accumulation of excessive fluid in the pericardium, the double-layered sac-like structure that surrounds the heart.

Usually, there is a thin layer of fluid between these layers. However, the inflammation that results from pericardial disease or injury can cause an overabundance of fluid. In addition, non-inflammatory fluid accumulation around the heart may result from bleeding associated with malignancy or from trauma to the chest.

The heart may experience pressure from pericardial effusion, which could alter the heart's function. In severe circumstances, it might result in death if left untreated.

Causes Of Pericardial Effusion

Following a disease or trauma, pericarditis, or inflammation of the pericardium, can cause pericardial effusion. Large effusions may result from specific malignancies in specific circumstances. This disorder may also result from a buildup of blood within the pericardium or an obstruction of pericardial fluids.

In certain cases, the cause is unknown (idiopathic pericarditis).

Pericardial effusions can be caused by the following:

• Autoimmune diseases, such as lupus or rheumatoid arthritis
• Heart or pericardial cancer 
• Metastasis, or the spread of disease, especially Hodgkin's lymphoma, breast cancer, or lung cancer
• Radiation treatment for cancer if the radiation reaches the heart
• Trauma to the chest
• Inflammation of the pericardium after a heart attack, heart surgery, or any operation that damages the lining of the heart
• Hypothyroidism: under-activity of the thyroid
• Usage of specific medications or exposure to poisons
• Infections caused by bacteria, fungi, viruses, or parasites
• Waste materials in the blood as a result of renal failure (uremia)

Also Read: Gilbert Syndrome: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

Symptoms Of Pericardial Effusion

A pericardial effusion may not show any obvious symptoms, especially if the fluid buildup has happened gradually.

Should indications and symptoms of pericardial effusion materialize, they may comprise:

• Breathing difficulties or shortness of breath (dyspnea)
• Breathing discomfort when lying down
• Chest pain, typically on the left side of the chest or behind the breastbone
• Fullness in the chest
• Dizziness or a faint feeling
• Swelling in the legs or abdomen

Diagnosis  Of Pericardial Effusion

The medical professional will usually conduct a physical examination and inquire about your symptoms and medical history to identify pericardial effusion. He or she will probably use a stethoscope to listen to your heart. Tests can assist in determining the cause of pericardial effusion if your doctor believes you have one.

Examinations

Examinations to identify or validate pericardial effusion could involve:

• Echocardiography: The heart in action can be visualized through the use of sound waves. An echocardiography displays the heart's chambers and the efficiency of its blood pumping. The test can assist in estimating the volume of fluid that exists between the pericardium's two layers. Tamponade, or reduced cardiac function as a result of strain on the heart, can also be seen on an echocardiography.
• Cardiogram (also known as ECG or EKG): The electrical activity of the heart is measured by this rapid and painless examination. Electrodes, or sticky patches, are applied to the arms, legs, and even the chest. The electrodes are wired into a computer, which shows the test findings. A healthcare professional such as your cardiologist may search for signal patterns that indicate cardiac tamponade.
• Chest radiography: A medical professional can examine the size and shape of the heart via a chest X-ray. If the effusion is significant, an enlarged heart may be visible on a chest X-ray.
• Pericardial effusion can be found with computed tomography (CT) and magnetic resonance imaging (MRI), though these tests are typically not utilized to search for the condition. However, if these tests are performed for other purposes, pericardial effusion may be identified.

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Treatment  Of Pericardial Effusion

Management of pericardial effusion is contingent upon:

• The amount of fluid accumulation
• The pericardial effusion's etiology
• The possibility or existence of heart tamponade

Drugs

Your doctor may recommend one of the following drugs to treat pericardial inflammation if you do not currently have cardiac tamponade or if there is no imminent risk of developing cardiac tamponade:

• Aspirin
• NSAIDs, or nonsteroidal anti-inflammatory medicines, include ibuprofen
• Colchicine 
• Prednisone is an example of a corticosteroid.

 Surgery or other procedures

Procedures to empty a pericardial effusion or stop further fluid accumulation could be advised by your healthcare professional if:

• The pericardial effusion cannot be treated with medication.
• In addition to producing symptoms, a significant effusion raises the possibility of cardiac tamponade.
• Your heart is tamponaded.

In order to treat pericardial effusion, drainage techniques or surgery may involve:

• Drainage of fluid (pericardiocentesis): A catheter—a tiny tube—is inserted by a medical professional after using a needle to create an opening in the pericardial region in order to drain the fluid. The work is guided by imaging tools, usually echocardiography. In order to assist avoid further fluid buildup, the catheter is typically left in place to drain the pericardial region for a few days. When no more fluid is accumulating and all of the fluid has drained out, the catheter is removed.
• Open cardiac surgery: Open heart surgery may be necessary to drain the pericardium and repair any damage if there is bleeding into the pericardium, particularly if it is the result of recent heart surgery or other complicating conditions. Occasionally, a surgeon might make a hole that lets fluid seep into the abdominal cavity as needed so that it can be absorbed there.
• Pericardiectomy, the removal of the pericardium: A surgeon may advise removing all or part of the pericardium if pericardial effusions persist after drainage techniques.

Also Read: Dyspnea: Causes, Symptoms, Types, Risk Factors, Diagnosis, Treatment and Prevention

Complications  Of Pericardial Effusion

Cardiac tamponade is a possible side effect of pericardial effusion. The extra fluid in the pericardium puts pressure on the heart in this situation. The pressure keeps the heart chambers from filling with blood all the way.

The body receives less oxygen and has inadequate blood flow as a result of cardiac tamponade. Life-threatening cardiac tamponade necessitates immediate medical attention.

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