Pericardial effusion is one of the most common heart ailments from which many people suffer today in the world (44). In this problem, excess fluid tends to get accumulated between the sac which surrounds the heart and the heart itself. The pericardium is nothing but the sac, which surrounds the heart. If the fluid deposition is not in excess amount, it will cause no problem. But when the deposition is high, it might lead to poor working of the heart impacting overall cardiac health as well as general health.
The pericardium is actually a layered sac, which is quite tough and strong. With the beating of the heart, the pericardium slides easily within the heart. In normal conditions, 2-3 tablespoons of yellow and clear pericardial fluid are present between the two layers of the sac. This fluid acts like a lubricant and helps the heart move easily within the sac with minimal friction. When a patient suffers from pericardial effusion the amount of fluid that gets accumulated between the heart and the sac increase significantly. While in some cases, the deposit volume would be about 100 milliliters of fluid; in grave situations, the deposition volume might be around 2 liters.
Causes of pericardial effusion
There are known as well as unknown causes for pericardial effusion. Most commonly, inflammation of the pericardial sac is responsible for the fluid accumulation. This condition is known as pericarditis in medical parlance. This leads to the effusion. More fluid is produced and stored with the inflamed sac.
The Major cause of inflammation is viral infections of various kinds. Some of the most common viral infections, which lead to pericardial effusion include:
- HIV
- Coxsackieviruses
- Echoviruses
- Cytomegalovirus
Apart from viral infections, there are many other conditions, which lead to pericardial effusion. Some of them include:
- Heart attack
- Cancer
- Injury to the heart or sac from some kind of medical procedure
- Autoimmune disease like rheumatoid arthritis, lupus etc
- Severe kidney failure, known as uremia in medical language
- Various kinds of bacterial infections, including that of tuberculosis
In many cases it has been seen that no particular cause has been found for the disease. For such situations, the doctor refers the effusions to be idiopathic pericardial effusions.
Symptoms of pericardial effusions
When pericardial effusion is caused due to inflammation of the pericardial sac, the most common symptom is chest pain. The pain gets worse when one breathes deeply. Slight relief is felt on leaning forward. The other prominent symptoms of pericardial effusion include:
- Muscle aches
- Fever
- Immense fatigue
- Shortness of breath
- Vomiting, nausea and diarrhea (this is more common in case of viral infections)
If inflammation of the sac does not take place, usually symptoms do not develop at all.
Even if pericardial effusions are large and serious or are small ones which have developed quickly, here are some of the visible symptoms for the same:
- Light-headedness or sense of passing out
- Palpitations are sensations in which the heart beats and pounds very fast
- Clammy and cool skin
- Shortness of breath
When such symptoms appear, it should be considered as a medical emergency and can be a life-threatening condition.
Treatment of pericardial effusion
The treatment plan chosen for pericardial effusion depends on the cause of the problem and the severity of the same. Small effusions which don’t have symptoms and are caused due to unknown causes need no special treatment. This is applicable for cases like kidney failure.
If the pericardial effusion is caused due to pericardial sac inflammation, the first treatment will be done to reduce the inflammation and that will cure the effusion as well. Medicines that are usually prescribed for treating inflammation and effusion include:
- Corticosteroids like Solu-Medrol and prednisone
- Non-steroidal anti-inflammatory drugs like Indocin, Aleve and Motrin
- Colchicine
In case severe infection takes place or there is condition of heart impairment, the accumulated fluid from the heart sac must be drained out on an emergency basis. There are two ways of draining out the excess fluid – pericardiectomy or pericardial window or by pericardiocentesis (45). General anesthesia might be required for the procedures. When such effusions are 3 months old or more, they are termed as chronic.