Pericardial effusion

Pericardial effusion ("fluid around the heart") is an abnormal accumulation of fluid in the pericardial cavity. Because of the limited amount of space in the pericardial cavity, fluid accumulation will lead to an increased intrapericardial pressure and this can negatively affect heart function. When there is a pericardial effusion with enough pressure to adversely affect heart function, this is called cardiac tamponade. Pericardial effusion usually results from a disturbed equilibrium between the production and re-absorption of pericardial fluid, or from a structural abnormality that allows fluid to enter the pericardial cavity.

Normal levels of pericardial fluid are from 15 to 50 mL.

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Types

It may be transudative (congestive heart failure, myxoedema, nephrotic syndrome), exudative (tuberculosis, spread from empyema) or haemorrhagic (trauma, rupture of aneuryms, malignant effusion).

Causes

• Pericarditis
• Viral infection
• Infection
• Inflammatory disorders, such as lupus and post myocardial infarction pericarditis (Dressler's syndrome)
• Cancer that has spread to the pericardium
• Kidney failure with excessive blood levels of urea nitrogen
• Heart surgery^[1]

Symptoms

Chest pain, pressure symptoms. A small effusion may have no symptoms.

Pericardial effusion is also present after a specific type of heart defect repair. An Atrial Septal Defect Secundum, or ASD, when repaired will most likely produce a pericardial effusion due to one of the methods of repair. One repair method of an ASD is to take a piece of the peridcardial tissue and use it as a patch for the hole in the atrial cavity.

The so-called "water-bottle heart" is a radiographic sign of pericardial effusion, in which the cardiopericardial silhouette is enlarged and assumes the shape of a flask or water bottle.

Treatment

Treatment depends on the underlying cause and the severity of the heart impairment. Pericardial effusion due to a viral infection usually goes away within a few weeks without treatment. Some pericardial effusions remain small and never need treatment. If the pericardial effusion is due to a condition such as lupus, treatment with anti-inflammatory medications may help. If the effusion is compromising heart function and causing cardiac tamponade, it will need to be drained, most commonly by a needle inserted through the chest wall and into the pericardial space. A drainage tube is often left in place for several days. In some cases, surgical drainage may be required by pericardiocentesis, in which a needle, and sometimes a catheter are used to drain excess fluid.

References

1. ^ Pericardial effusion:What are the symptoms?, Dr. Martha Grogan M.D.