Pericardial effusion

Alternative Names

Pericarditis

What is Pericardial effusion

Pericardial effusion is the accumulation of excess water around the heart. In most cases, this condition is related to inflammation of the pericardium that's caused by disease or injury, but pericardial effusion can also occur without inflammation. Sometimes, pericardial effusion can be caused by the accumulation of blood after a surgical procedure or injury.

Pericardial effusion is classified as:

• transudative (congestive heart failure, myxoedema, nephrotic syndrome)
• exudative (tuberculosis, spread from empyema)
• haemorrhagic (trauma, rupture of aneurysms, malignant effusion)
• malignant (due to fluid accumulation caused by metastasis)

Signs and symptoms

The most common symptoms of pericardial effusion include:

• shortness of breath or difficulty breathing (dyspnea)
• shortness of breath when lying down (orthopnea)
• chest pain, usually behind the breastbone or on the left side of the chest that often feels worse when you breathe and feels better when you are sitting up, rather than lying down
• cough
• painful breathing, especially when inhaling or lying down
• fainting or dizziness
• low-grade fever
• rapid heart rate
• a feeling of anxiety

Possible complications

Pericardial effusion can trigger the following complications:

• pericardial tamponade (this can lead to severe haemodynamic compromise and death)
• chronic pericardial effusion (these are effusions lasting longer than 6 months and they are usually well tolerated)

What causes

In most cases pericardial effusion is triggered by:

• pericarditis
• viral infection (coxsackie virus)
• infection
• inflammatory disorders, such as lupus and post myocardial infarction pericarditis (Dressler's syndrome)
• cancer tha
t has spread to the pericardium
• trichinosis
• kidney failure with excessive blood levels of urea nitrogen
• minoxidil
• hypothyroidism
• heart surgery (postpericardotomy syndrome)

Prevention

In most cases this condition is not preventable. However, nowadays there are some methods of promt treatment and prevention of pericardial effusion.

Treatment

It is important to discuss the treatment with your doctor. Treatment depends on the underlying cause and the severity of the heart impairment. Pericardial effusion that is caused by a viral infection usually goes away within a few weeks without treatment. Some pericardial effusions remain small and do not require treatment.

It is also possible to treat pericardial effusion by means of medical management:

• nonsteroidal antiinflammatory medications (NSAIDs) can be used to treat pericardial effusions caused by inflammation
• diuretics and other heart failure medications can be used to treat pericardial effusions caused by heart failure
• antibiotics are used to treat pericardial effusions caused by an infection
• if a pericardial effusion is related to the presence of cancer, treatment may include chemotherapy, radiation therapy, or medication infused within the chest