Pericardial effusion is the medical term for fluid buildup in the space around the heart. More specifically, the fluid appears between the membrane sac lining that surrounds the heart, the pericardium, and the heart itself.
Some people with pericardial effusion may not show any symptoms, and doctors may discover the condition by chance — for example, if they notice fluid around the heart spaces in medical imaging that they have conducted for a different purpose.
In other cases, those with pericardial effusion may experience life threatening drops in the heart’s ability to function.
When fluid collects around the heart, it is always a serious matter, but the specific cause will determine the severity of the condition and the treatment options. Keep reading to learn more.
The causes of pericardial effusion include:
- viral, bacterial, fungal, or, in rare cases, parasitic infection
- rheumatoid arthritis, lupus, and other autoimmune diseases
- kidney failure that leads to waste products in the blood
- metastasized cancer
- heart surgery
- some medications, such as minoxidil, penicillin, and methysergide
- chemotherapy drugs
- wounds near the heart
- underactive thyroid
- inflammation of organs
- tuberculosis, which is more likely to be a factor in developing countries
Scientists have found that in 60% of cases, the buildup of fluid around the heart is linked to a known disease.
Studies have shown that 21% of people with a cancer diagnosis develop pericardial effusion. The cancers most frequently associated with this kind of fluid buildup are lung cancer, breast cancer, lymphoma, and leukemia.
The pericardial sac typically contains 10–50 milliliters of fluid, but when pericardial effusion develops, the fluid quantity can increase and cause a variety of reactions throughout the body.
Whether or not a person presents with symptoms often depends on how rapidly the fluid accumulates, rather than on the amount of fluid.
Fluid around heart spaces does not always cause symptoms, especially in the early stages, because the pericardium can stretch. However, when fluid does build up, it puts pressure on nearby organs and parts of the body, including the lungs, stomach, nerves, and heart.
The resulting symptoms include:
- shortness of breath
- chest pain that gets worse when people lie flat
- reduced ability to exercise
- feeling of fullness in the abdomen
- problems with swallowing
- feeling lightheaded
When fluid builds up rapidly in the pericardium, it puts so much pressure on the heart that this organ cannot do its job properly. This condition is called cardiac tamponade. As it is potentially life threatening, it is important to take these symptoms very seriously:
- the lips and skin turning blue
- a marked change in mental state
- the individual going into shock
Doctors tend to opt for conservative treatment of pericardial effusion when the affected individual does not have any symptoms and the amount of fluid is small. If the individual has multiple symptoms and a lot of fluid, doctors are more likely to use drainage techniques.
Accurately diagnosing the cause of a fluid buildup around an individual’s heart involves the following steps:
- taking a complete medical history
- carrying out a physical examination
- ordering diagnostic tests
- using medical imaging
- analyzing fluid samples from the pericardium
Medical imaging is an effective way to determine whether someone has fluid around the heart. When a doctor suspects that a person has this condition, researchers recommend that they use an echocardiogram as their first diagnostic tool. This test can also show doctors the amount and location of the fluid.
Other tests include:
- chest X-ray
- CT scan
- cardiac MRI
Pericardiocentesis is another important tool that doctors use to determine what causes pericardial effusion. This procedure involves using a needle to remove a sample of the fluid around the heart for analysis. Sometimes, it is necessary to leave a drain in the pericardial space to remove all the fluid from the sac.
The consistency of the fluid, which could be either watery or high in protein, helps doctors determine what is causing the fluid buildup and how best to treat it.
Researchers report that although the procedure is risky, it can be a potentially lifesaving technique for people with cardiac tamponade.
When people do not have cardiac tamponade, doctors do not usually use pericardiocentesis to diagnose fluid around heart spaces unless the medical team is concerned about bacterial infection.
The treatment for fluid around the heart depends on what is causing the buildup, but it may involve medications and various procedures. These include:
- ibuprofen, aspirin, and other nonsteroidal anti-inflammatory drugs, which can help control inflammation
- diuretics, which can treat fluid buildup due to heart failure
- antibiotics to control bacterial infections
- pericardiocentesis to diagnose and treat fluid around heart spaces
- video-assisted thoracoscopic surgery (VATS), also known as thoracoscopy, which is a somewhat more invasive procedure that allows doctors to see inside the chest and heart more clearly and drain excess fluid
- minimally invasive surgery to create a pericardial window for draining fluid (more common when people have recurring episodes of pericardial effusion)
- balloon pericardiotomy, which is an uncommon procedure that uses a catheter and a balloon to dilate the pericardium
Fluid around the heart, or pericardial effusion, is a significant health problem with many possible causes. The cause will determine the severity of the condition and the treatment options.
In some cases, people with this kind of fluid buildup may not have any symptoms. In others, they may develop shortness of breath, nausea, and a host of symptoms that interfere with their everyday lives.
Some individuals may develop cardiac tamponade, which can be life threatening.
Doctors treat this condition by addressing the cause, such as bringing a bacterial infection under control, and managing the excess fluid around the heart as necessary.