CONDITIONS
Pericardial Disease
Pericardial Disease (Pericardial effusion)
Problems with the pericardium include –
- Pericarditis – Inflammation of the sac occurring from a virus or any other infection.
- Pericardial effusion – the buildup of fluid in the pericardium
- Cardiac tamponade – when the buildup of fluid in the sac causes problems with the heart functioning.
Pericardial effusion is the buildup of too much fluid between the heart and the pericardium (double-layered, saclike structure around the heart).
The pericardium is a membrane, or sac-like structure surrounding the heart that holds the heart in place while aiding in normal function of it. The fluid in it keeps the heart in a stable place in the chest as the heart beats.
What are the symptoms of Pericardial effusion?
- Shortness of breath or difficulty breathing (dyspnea)
- Difficulty in breathing while lying down posture.
- Chest pain, usually behind the breastbone or on the left side of the chest
- Palpitations (a sensation of the heart racing, pounding, fluttering, or skipping a beat)
- Dizziness, lightheadedness or feeling faint.
- Swelling in the abdomen or legs
- Altered mental status, such as confusion or agitation.
- Larger effusions may put pressure on the surrounding tissues or nerves, causing:
- Trouble swallowing (dysphagia)
- Hiccups
- Coughing or hoarseness
Severe form of Pericardial Effusion – Cardiac Tamponade:
When the fluid gathered in the pericardium prevents the heart from filling with blood and working properly, cardiac tamponade occurs and is a life-threatening condition needing emergency treatment right away.What are the causes and risk factors of Pericardial effusion?
- Pericarditis (inflammation of the pericardium).
- Infections – caused by viruses (such as HIV), bacteria (such as tuberculosis)
- Autoimmune conditions (where the immune system attacks the body)
- Hormone disorders
- Trauma or injury to the chest
- Heart problems, such as a heart attack, heart failure
- Side effects from medical treatments (heart surgery, radiation therapy for cancer) or certain medications.
- Medical conditions complications
How is Pericardial effusion diagnosed?
A physical exam by the doctor is conducted in which he/she may listen to the patient’s heart with a stethoscope. The following tests may help identify the cause:
Echocardiogram (2D echo): Sound waves are used to show blood flow through the heart. This assesses the condition of the heart, if oxygen flow is restricted to heart or any of the heart valves. It may also help determine the amount of fluid between the two layers of the pericardium and may show a decreased heart function due to pressure on the heart (tamponade).
Electrocardiogram (ECG or EKG):
- Quick and painless test procedure to measure the electrical activity of the heart.
- Sensors (electrodes) are attached to the chest, wires connect the sensors to a machine, displaying or printing the results.
- ECG helps to determine if blood flow to the heart has been reduced.
Chest X-ray:
The images provided by the chest X-ray allows the doctor to check the size and shape of the heart and in case the effusion is large, the chest X-ray may show signs of an enlarged heart.
What are the treatment options for Pericardial effusion?
Treatment depends on:
- The amount of fluid buildup
- The cause of pericardial effusion
- The presence or risk of cardiac tamponade
For a large effusion or cardiac tamponade, the fluid must be drained. Following methods could be used for the same:
Pericardiocentesis – extra fluid is pulled out with a needle and if necessary, a tube is left in the chest (pericardial drain) for a few days to drain the fluid completely.
Open-heart surgery – In the presence of bleeding into the pericardium, especially due to a recent heart surgery or other complicating factors, open-heart surgery is recommended by the doctor.
Percutaneous balloon pericardiotomy – The surgeon uses X-rays to insert a long, thin tube with a small balloon at the end into the pericardium. The balloon is inflated to make the hole bigger to drain out the extra fluid.
Pericardiectomy – Removing all or part of the pericardium if the fluid keeps collecting despite drainage procedures.
Effusions that are not as dangerous and not in need of immediate drainage, usually medications or other options that include treating the cause of effusion is advised by the doctor, such as:
- Antibiotics, for bacterial infections for tuberculosis
- Anti-inflammatory drugs to reduce any inflammation and swelling
- Chemotherapy and radiation therapy in cancer cases
- Diuretics and other medicines in heart failure
References
- Pericardial Disorders. Medline Plus. March 2024. https://medlineplus.gov/pericardialdisorders.html
- Pericardial Disease. Mayo Clinic. March 2024. https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/diagnosis-treatment/drc-20350619
- What Is Pericardial Disease? WebMD. March 2024. https://www.webmd.com/heart-disease/coronary-artery-disease
