About Pericardial Effusion
What Is Pleuropericardial Effusion?
The excess fluid puts pressure on the heart, which can lead to symptoms such as chest pressure or pain, shortness of breath, difficulty breathing when lying down, nausea, a feeling of fullness in the chest, and trouble swallowing. Pericardial effusion can be a serious condition that requires medical intervention to relieve the pressure on the heart. Tests like echocardiogram, chest X-ray, electrocardiogram (ECG), computed tomography (CT), or cardiac magnetic resonance imaging (MRI) can help confirm the presence and severity of pericardial effusion. Treatment options may include pericardiocentesis (draining the fluid) or surgical procedures like pericardiectomy (the surgical removal of all or part of the pericardium).
Pleuropericardial Effusion Causes and Risk Factors
Pericardial effusion can develop when inflammation, injury, illness, or other factors cause too much fluid to collect in the pericardium, the sac around the heart. In some cases, the exact cause is not known.
Possible causes include:
- Inflammatory or autoimmune conditions: Conditions such as lupus or rheumatoid arthritis can inflame the pericardium and lead to fluid buildup.
- Infections: Viral, bacterial, fungal, or parasitic infections may cause inflammation and effusion.
- Cancer: Fluid can collect if cancer spreads to the pericardium, particularly with cancers such as lung cancer, breast cancer, lymphoma, or leukemia.
- Underactive thyroid: Severe hypothyroidism can sometimes contribute to pericardial effusion.
- Kidney failure: Waste products that build up in the blood because of kidney failure can irritate the pericardium and cause fluid to collect.
- Heart-related injury or procedures: A heart attack, heart surgery, or procedures involving the heart may trigger inflammation around the heart.
- Chest injury or cancer treatment: Trauma to the chest or radiation therapy near the heart can increase the chance of fluid buildup.
- Medications or toxins: Some medicines and toxin exposures have been linked to pericardial effusion.
Risk factors include anything that can damage or inflame the pericardium. These may include infections, recent heart surgery, medical conditions affecting the heart, lungs, or nearby organs, and some cancer treatments.
Risk factors that cannot be changed may include:
- Age: Pericardial effusion may be more common in older adults.
- Sex: Some pericardial conditions are reported more often in males.
Risk factors that can be changed are not well established. A healthcare professional can help identify the likely cause of an effusion and discuss any steps that may reduce future risk based on a person’s health history.
Pleuropericardial Effusion Symptoms
Pericardial effusion does not always cause symptoms, especially when the fluid builds up slowly or the amount of fluid is small. When symptoms do occur, they may depend on how much fluid has collected and how quickly it developed.
Common symptoms may include:
- Shortness of breath or trouble breathing
- Breathing discomfort when lying down
- Chest pain, pressure, or a feeling of fullness, often behind the breastbone or on the left side of the chest
- Lightheadedness, dizziness, or feeling faint
- Swelling in the legs or belly
- Fatigue or weakness
- Cough, hoarseness, trouble swallowing, or hiccups, which can happen if the fluid presses on nearby structures
A large or quickly developing effusion can sometimes lead to cardiac tamponade, a medical emergency that happens when fluid puts enough pressure on the heart to affect how it pumps blood.
Seek emergency medical care right away if symptoms include:
- Chest pain that lasts more than a few minutes
- Severe, difficult, or painful breathing
- Fainting or unexplained loss of consciousness
- Very low blood pressure, rapid heartbeat, or sudden weakness
Some signs of pericardial effusion or cardiac tamponade may only be found during a medical exam or testing, such as muffled heart sounds, bulging neck veins, or changes in blood pressure while breathing. A healthcare professional can evaluate symptoms and determine whether testing is needed.
Diagnosing Pleuropericardial Effusion
A healthcare professional may suspect pericardial effusion based on symptoms, medical history, and a physical exam. During the exam, they may listen to the heart and lungs and check for signs that fluid around the heart is affecting blood flow.
Tests used to diagnose or evaluate pericardial effusion may include:
- Echocardiogram: This ultrasound test uses sound waves to create moving images of the heart. It is commonly used to confirm whether fluid is present, estimate how much fluid has collected, and check whether the fluid is affecting how the heart pumps.
- Electrocardiogram, also called ECG or EKG: This quick test records the heart’s electrical activity. Certain patterns may suggest inflammation around the heart or pressure on the heart from a large effusion.
- Chest X-ray: This imaging test can show the size and shape of the heart. A large effusion may make the heart look bigger than usual.
- CT scan or cardiac MRI: These imaging tests can provide more detailed pictures of the heart, pericardium, and nearby structures. They may be used when more information is needed or when the effusion is found during imaging for another reason.
- Blood tests: Blood tests may help look for inflammation, infection, thyroid problems, kidney disease, heart injury, autoimmune conditions, or other possible causes.
- Pericardiocentesis: If the effusion is large, causing symptoms, or the cause is unclear, a healthcare professional may remove fluid from around the heart with a needle or small tube. The fluid can be tested in a lab for infection, cancer cells, inflammation, or other clues about the cause.
The choice of tests depends on a person’s symptoms, exam findings, medical history, and how urgently the condition needs to be treated. If cardiac tamponade is suspected, diagnosis and treatment may need to happen quickly because it can be life-threatening.
Pleuropericardial Effusion Treatment Options
Treatment for pericardial effusion depends on the amount of fluid around the heart, what caused it, whether symptoms are present, and whether there is a risk of cardiac tamponade. Some small effusions may only need monitoring, while larger or rapidly developing effusions may need urgent treatment.
Treatment options may include:
- Monitoring: If the effusion is small and not causing symptoms, a healthcare professional may recommend follow-up visits and repeat imaging to see whether the fluid changes over time.
- Medicines to reduce inflammation: If inflammation is contributing to the effusion, treatment may include medicines such as aspirin, nonsteroidal anti-inflammatory drugs, also called NSAIDs, colchicine, or corticosteroids. The choice depends on the cause and a person’s overall health.
- Treatment for the underlying cause: If the effusion is related to an infection, cancer, kidney disease, thyroid disease, autoimmune condition, or another medical problem, treating that condition is an important part of care.
- Pericardiocentesis: This procedure uses a needle and a small tube to drain extra fluid from the sac around the heart. It may be done when the effusion is large, causing symptoms, or creating pressure on the heart. The fluid may also be tested to help identify the cause.
- Procedures or surgery to prevent fluid from coming back: If fluid returns or cannot be managed with drainage alone, a healthcare professional may recommend a procedure to create a drainage opening or surgery to remove part or all of the pericardium.
If cardiac tamponade is suspected, treatment is an emergency and usually involves quickly draining the fluid to relieve pressure on the heart.
A healthcare professional can recommend the safest treatment plan based on the cause of the effusion, symptoms, test results, and overall health. Medication dosing, side effects, and interactions can vary, so people should follow the instructions provided by their healthcare professional or pharmacist.