What Is Pericardial Effusion?
The medical in which there is excessive fluid buildup around the heart is termed as Pericardial Effusion. Surrounding the heart is a sac like structure which is called the pericardium. This pericardium has two layers and in between the layers there is a small amount of fluid. In cases when there is an injury to the pericardium this results in inflammation of the pericardium with resultant excessive fluid buildup causing Pericardial Effusion. In some cases Pericardial Effusion can be caused due to pooling of blood in the pericardium after a surgical procedure. This excessive fluid buildup starts to put pressure on the heart adversely affecting the functioning of the heart. This condition needs to be treated as it may result in potentially serious complications to include heart failure.
What Causes Pericardial Effusion?
Pericardial inflammation which is also known as pericarditis develops after an injury or a disease to the pericardium. This inflammation then results in development of Pericardial Effusion. This condition may also occur when there is blockage of flow of the pericardial fluids or pooling of blood after a surgical procedure. There are also some disease conditions which can result in Pericardial Effusion but the exact cause as to why they cause it is not entirely clear. Some of the medical conditions that may result in Pericardial Effusion are:
- Viral or bacterial infections
- Pericarditis due to surgery
- Rheumatoid Arthritis
- Lung or breast cancer
- Radiation and chemotherapy
- Direct trauma to the pericardium like a bullet wound.
What Are The Symptoms Of Pericardial Effusion?
Some of the symptoms of Pericardial Effusion are:
- Chest pain
- Persistent Cough
- Low-grade fever
How Is Pericardial Effusion Diagnosed?
To begin with, the treating physician will take a detailed history as to when the symptoms started, whether there is shortness of breath with exertion or even at rest. The physician will then perform a physical examination where he or she will listen to the heartbeat looking for any abnormal sound which in the case of Pericardial Effusion will be a high pitched noise called as friction rub. If a Pericardial Effusion is suspected then the physician may refer you to a cardiologist for specialized testing and confirm the diagnosis. Some of the tests that the cardiologist may perform are:
Electrocardiogram: This test shows the heartbeat in the form of electrical impulses. This test can show whether there is any abnormality in the rhythm of the heart and whether the heart is functioning normally.
Echocardiogram: This test makes use of ultrasound waves to look at the functioning of the heart. This test can accurately identify any abnormality of the functioning of the heart.
Transesophageal Echocardiogram: This is a form of echocardiogram in which images of the heart are obtained through a transducer that is inserted into the esophagus.
Chest X-ray: This can reveal whether there is any enlargement of the heart or not which can rule in or rule out cardiomegaly as a cause of the heart murmur.
Apart from these tests a CT scan or an MRI will also be obtained which can accurately detect presence of Pericardial Effusion.
If Pericardial Effusion is confirmed than the physician may order blood tests to identify the cause of it and then formulate a definitive plan for treatment of Pericardial Effusion.
How Is Pericardial Effusion Treated?
The amount of fluid accumulated in the pericardium decides the mode of treatment for the affected individual and whether the effusion is severe enough to put pressure on the heart and reduce the function of the heart. This is also called as cardiac tamponade. Once the cause of Pericardial Effusion is treated more often than not the effusion resolves.
For treatment to begin with medications will be administered to reduce the inflammation of the pericardium. Some of the medications administered are aspirin, NSAIDs like ibuprofen or Indocin, colchicine. In case if these medications are not effective in decreasing the effusion the physician may then try a steroid like prednisone to decrease the inflammation and thus help resolve the effusion.
If antiinflammatory agents are not helpful in decreasing the inflammation and the amount of fluid is severe enough to put you at risk for a cardiac dysfunction then the physician may employ the following methods for treatment in order to drain the fluid from the pericardium and prevent recurrence of accumulation. These methods are:
Paracentesis: To do this, a small catheter may be inserted in the pericardium and the fluid accumulated will be drained. This procedure is called pericardiocentesis. This is normally done under fluoroscopic guidance for accurate insertion.
Open Heart Surgery: In case the effusion is caused due to bleeding from a recent heart surgery a surgical procedure may be required for drainage of the pericardium and repair any defect that may be caused due to the condition. In some cases, the surgeon created a path from the pericardium to the abdominal cavity so that any excess fluid goes through this path into the abdominal cavity where it is absorbed.
In some cases, the surgeon may join the two layers of the pericardium together. This procedure is called intrapericardial sclerosis. In this procedure a solution is inserted into the pericardium which effectively seals the two layers of the pericardium together. This procedure is done in recurrent cases of Pericardial Effusion.
In some cases the entire pericardium may be removed. This procedure is called as Pericardiectomy. This procedure is done for recurrent episodes of Pericardial Effusion. Is should be noted that there is no change in the function of the heart without the pericardium and is also an effective way of preventing recurrent Pericardial Effusion.