When the pericardial layer sac is filled with excess of fluid it leads to pericardial effusion. Excess of fluid surrounding the heart may exert pressure interfering with the normal functions of the heart. The pericardium develops inflammation and injured. In some cases the gap between the layers are filled with blood due to accidental injury or after heart surgery. This can also cause effusion. If left untreated for long, pericardial effusion may lead to collapse of heart and even death.
Symptoms :
Generally people with pericardial effusion will not experience any symptom due to accumulation of excess of fluid. This does not happen suddenly and in most of the cases it is a gradual process. However some people may have signs like breathing difficulty, persistent cough, shortness of breath, chest pain (at the back of breastbone) and rapid heartbeat.
Mild pain on the chest may increase when the person inhales air and the pain may get better if he sits down. He may become extremely tired for no apparent reason. In case large volumes of fluid collect in the layer suddenly it can cause rapid heartbeat, difficulty in breathing and clammy skin. The person may suddenly lose consciousness.
Causes :
- Pericardium (double layered sac) develops inflammation due to injury or disease and due to accumulation of excess of fluid inside. This is the major cause of pericardial effusion.
- For some people, pericardial effusion may be idiopathic (cause not known).
- Prolonged infections from bacteria or virus can cause inflammation of pericardium.
- Effusion can occur as side effect of Heart Attack or heart surgery. For some people Rheumatoid Arthritis can cause this problem.
- If case kidney is not functioning properly, it may lead to pericardial effusion.
- Lung Cancer, undergoing radiation and chemotherapy for any other cancer can cause pericardial effusion.
- Certain medications like hydralazine (given for Hypertension) and drugs like phenytoin given for Epilepsy can cause effusion.
Complications :
Pericardial layer can withhold only 2-3 tablespoon of fluid in its limited space. The inner layer of pericardium lies in close contact with the heart and any excess of fluid content can exert pressure on the heart disrupting its function. The chambers of the heart (auricles and ventricles) may not be able to fill blood normally due to effusion which can lead to several complications. The heart may collapse partially leading to poor circulation of oxygenated blood to the body. This condition is known as tamponade which can be fatal.
Tests :
Your doctor may listen to the symptoms and using a stethoscope she would listen to the heartbeat. If there is any friction or rubbing noise it can be due to pericardial effusion. She may order for further tests like echocardiogram and transthoracic echo to get a clear picture of your heart. ECG test may also be done to record the signals emitted from the heart checking for tamponade. In case the results indicate presence of excess of fluid inside the layer, the doctor will have to look into the cause of the problem.
Treatment :
The goal of treating pericardial effusion is to normalize the function of the heart and to drain out excess of fluid from pericardial sac. Drugs like aspirin or colchicines can be given for reducing the inflammation of the layer and improving the symptoms. For people who are not responding to the above drugs steroids are prescribed. For severe case of pericardial effusion that interferes with the normal function of the heart, surgical process is the best option.
The doctor may drain off the fluid by using a small catheter that is inserted into the pericardial sac. This is an invasive surgery done under the influence of anesthesia and the patient should be in the hospital for few days or a week after surgery. Open heart surgery is to be done for patients who are bleeding inside the heart. For some cases, the surgeon would seal the layers of pericardium together if the patient develops recurrent pericardial effusion. In rare cases the entire portion of pericardium is removed during surgery.
Outlook :
In most of the cases, early diagnoses can prevent any complications due to pericardial effusion. The patient can recover completely with proper medications or surgery.
