Pericardial Effusion

Fluid buildup around the heart, called pericardial effusion, happens when too much fluid collects in the sac-like covering around the heart (pericardium).

Normally, a small amount of fluid sits between the layers of this covering, allowing the heart to beat smoothly. However, if the pericardium becomes inflamed, for example due to an infection or injury, this can cause extra fluid to collect. Fluid can also accumulate without inflammation, such as from internal bleeding, cancer, or an injury to the chest.

This extra fluid puts pressure on the heart, which can make it harder for the heart to pump blood efficiently. If the pressure isn't relieved, it can lead to serious problems, including heart failure and, in severe cases, death.

Fluid buildup around the heart (pericardial effusion) can sometimes happen without any noticeable problems, especially if it develops gradually.

However, if symptoms do appear, they might include:

• Shortness of breath (dyspnea): This means having trouble breathing, feeling winded, or needing to catch your breath more often than usual.
• Trouble breathing when lying down: Lying flat can make breathing more difficult. This is because the fluid can press on the lungs.
• Chest pain: This pain is often felt behind the breastbone or on the left side of the chest. The pain might feel like a dull ache or a sharp, stabbing sensation.
• Feeling of fullness in the chest: This is similar to feeling like your chest is tight or squeezed.
• Feeling lightheaded or faint: This can happen because the fluid buildup puts pressure on the heart, affecting blood flow to the brain.
• Swelling in the abdomen or legs (edema): This swelling is a sign that fluid is accumulating in the body, and it can be a symptom of various conditions, including pericardial effusion.

These symptoms can be subtle and easily missed, especially if they develop gradually. If you experience any of these, it's important to see a doctor to get a proper diagnosis and treatment.

If you have chest pain lasting more than a few minutes, trouble breathing, or a sudden, unexplained fainting episode, call 911 or your local emergency number immediately. These are serious situations that require urgent medical attention.

If you're having trouble breathing, even if it's not severe, it's a good idea to see your doctor. Shortness of breath can be a sign of a variety of health problems, some of which might need medical care. Don't ignore it.

Pericardial effusion happens when too much fluid builds up around the heart. This fluid buildup can be a result of inflammation of the heart's lining (pericardium), often following an illness or injury. Sometimes, large amounts of fluid buildup are linked to cancer. Blockages in the flow of fluid around the heart or the presence of blood in this space can also cause it.

In some cases, doctors can't pinpoint the exact cause (this is called idiopathic pericarditis).

Here are some things that can cause pericardial effusion:

• Inflammatory conditions: Problems like rheumatoid arthritis or lupus, where the body's immune system attacks healthy tissues, can lead to pericarditis and subsequent fluid buildup.
• Cancer: Cancers that start in the heart or pericardium can cause effusion. Cancer that has spread to the heart (metastasis), especially from the lungs, breasts, or Hodgkin's lymphoma, can also be a factor.
• Radiation therapy: If radiation treatment for cancer is directed near the heart, it can sometimes cause inflammation and fluid buildup.
• Injury: A physical injury to the chest can lead to pericardial effusion.
• Heart problems: A heart attack, heart surgery, or procedures that damage the heart lining can result in inflammation and fluid buildup around the heart.
• Thyroid issues: An underactive thyroid (hypothyroidism) can sometimes contribute to the problem.
• Medications and toxins: Certain medications or exposure to toxins can cause inflammation of the pericardium, leading to effusion.
• Infections: Viral, bacterial, fungal, or parasitic infections can also cause pericarditis and fluid buildup.
• Kidney failure: Waste products building up in the blood due to kidney failure (uremia) can trigger inflammation and fluid buildup.

It's important to remember that these are just some possible causes. A doctor will need to evaluate each individual case to determine the specific reason for the pericardial effusion.

Pericardial effusion is a buildup of fluid around the heart. Sometimes, this fluid buildup can become a serious problem called cardiac tamponade. In cardiac tamponade, the extra fluid presses against the heart, making it hard for the heart to fill with blood. This prevents the heart from pumping enough blood to the rest of the body, leading to a lack of oxygen and poor blood flow. This is a very serious condition that requires immediate medical attention.

Doctors diagnose pericardial effusion (fluid buildup around the heart) by first checking you over physically and asking about your symptoms and medical history. They'll likely listen to your heart with a stethoscope. If they suspect pericardial effusion, more tests are needed to find the cause.

Several tests can help confirm the diagnosis or find the reason for the fluid buildup:

• CT and MRI scans: These scans can sometimes show pericardial effusion, but they're usually not used specifically to look for it. If these scans are done for other reasons, pericardial effusion might be a finding. Essentially, they aren't the best tools for finding the fluid directly.

• Echocardiogram: An echocardiogram uses sound waves to create pictures of your heart while it's beating. This shows the heart's chambers and how effectively it pumps blood. Crucially, it can show how much fluid is between the heart's protective layers (pericardium). It can also reveal if the fluid is putting pressure on the heart (a condition called cardiac tamponade), which would affect how well the heart works.

• Electrocardiogram (ECG or EKG): This simple test measures the heart's electrical activity. Small sticky patches (electrodes) are placed on your chest, and sometimes your arms and legs. Wires connect these to a machine that displays the results. A doctor can look for specific patterns on the ECG that might suggest cardiac tamponade.

• Chest X-ray: A chest X-ray creates an image of your chest, showing the size and shape of your heart. If there's a significant amount of fluid buildup (effusion), the X-ray might show an enlarged heart. This isn't the primary way to diagnose pericardial effusion, but it can be helpful if other tests are done.

In short, doctors use a combination of physical exams, questions, and tests to accurately diagnose pericardial effusion and determine the best course of treatment.

Treating pericardial effusion depends on several factors:

• How much fluid is built up?
• What's causing the fluid buildup?
• Is there a risk of the heart being squeezed (cardiac tamponade)?

If there's no immediate danger of cardiac tamponade, your doctor might prescribe medicine to reduce inflammation around the heart. These medicines include:

• Pain relievers: Aspirin and ibuprofen (like Advil or Motrin) can help reduce pain and inflammation.
• Colchicine: This medicine can help with inflammation.
• Corticosteroids: These powerful anti-inflammatory drugs, like prednisone, may be used in some cases.

Procedures to drain the fluid or prevent future buildup might be necessary if:

• Medicine doesn't work: If the medicine doesn't help clear the fluid, drainage may be needed.
• Fluid buildup causes problems: If a lot of fluid is building up and causing symptoms, like shortness of breath, or increasing the risk of the heart being squeezed, drainage is important.
• Cardiac tamponade is present: If the heart is already being squeezed, immediate drainage is needed.

Different procedures to remove the fluid include:

• Pericardiocentesis: A needle and small tube (catheter) are used to drain the fluid from the space around the heart. Doctors often use imaging (like an echocardiogram) to guide the procedure. The tube might stay in place for a few days to help prevent more fluid from collecting. Once the fluid is gone and not coming back, the tube is removed.
• Open-heart surgery: If there's bleeding around the heart, especially after heart surgery, open-heart surgery might be needed to drain the fluid and fix any damage. In some cases, a surgeon might create a channel to let fluid drain into the belly, where it can be absorbed by the body.
• Pericardiectomy: If fluid buildup keeps happening despite drainage procedures, a surgeon might remove all or part of the sac surrounding the heart (the pericardium). This is a more serious operation, typically reserved for cases where other methods haven't worked.

It's crucial to discuss the best treatment options with your doctor, as the appropriate approach depends on your specific situation.