Pericardial effusio2

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Pericardial effusion By Mayo Clinic staff

Original Article:http://www.mayoclinic.com/health/pericardial-effusion/DS01124

Definition Pericardial effusion (per-ih-KAHR-de-ul uh-FU-zhun) is the accumulation of excess fluidaround the heart.

The heart is surrounded by a double-layered, sac-like structure called the pericardium.The space between the layers normally contains a very small amount of fluid.

Pericardial effusion is often related to inflammation of the pericardium that's caused bydisease or injury, but pericardial effusion can also occur without inflammation.

Sometimes, pericardial effusion can be caused by the accumulation of blood after asurgical procedure or injury.

When the volume of fluid exceeds the pericardium's "full" level, pericardial effusion putspressure on the heart, causing poor heart function. If left untreated, pericardial effusioncan cause heart failure or death.

Symptoms

Pericardial effusion symptoms may include:

Shortness of breath or difficulty breathing (dyspnea)

Shortness of breath when lying down (orthopnea)

Chest pain, usually behind the breastbone or on the left side of the chest that often feels

worse when you breathe and feels better when you are sitting up, rather than lying

down

Cough

Painful breathing, especially when inhaling or lying down

Fainting or dizziness

Low-grade fever

Rapid heart rate

A feeling of anxiety

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You can have significant pericardial effusion and experience no signs or symptoms,particularly if the fluid has increased slowly.

When to see a doctorCall 911 or your local emergency number if you feel chest pain that lasts more than a

few minutes, if your breathing is difficult or painful, or if you have an unexplained faintingspell. If you experience shortness of breath, fatigue or other symptoms of pericardialeffusion, see your doctor.

Causes

Inflammation of the pericardium (pericarditis) is a response to disease, injury or aninflammatory disorder that affects the pericardium. Pericardial effusion is a sign of thisinflammatory response.

Pericardial effusion may also occur when the flow of pericardial fluids is blocked or

when blood accumulates within the pericardium. It's not clear how some diseasescontribute to pericardial effusion, and sometimes the cause can't be determined.

Specific causes of pericardial effusion may include:

Viral, bacterial, fungal or parasitic infections

Inflammation of the pericardium due to unknown cause (idiopathic pericarditis)

Inflammation of the pericardium following heart surgery or a heart attack (Dressler's

syndrome)

Autoimmune disorders, such as rheumatoid arthritis or lupus

Waste products in the blood due to kidney failure (uremia)

Underactive thyroid (hypothyroidism)

HIV/AIDS

Spread of cancer (metastasis), particularly lung cancer, breast cancer, melanoma,

leukemia, non-Hodgkin's lymphoma or Hodgkin's disease

Cancer of the pericardium or heart

Radiation therapy for cancer if the heart was within the field of radiation

Chemotherapy treatment for cancer, such as doxorubicin (Doxil) and cyclophosphamide

(Cytoxan)



Trauma or puncture wound near the heart

Certain prescription drugs, including hydralazine, a medication for high blood pressure;

isoniazid, a tuberculosis drug; and phenytoin (Dilantin, Phenytek, others), a medication

for epileptic seizures

Complications

The pericardium can hold only a limited amount of excess fluid without causingproblems. The inner layer of the pericardium is made of a single layer of cells that sticksto the heart. The outer layer is thicker and only somewhat elastic. When too much liquidaccumulates, the pericardium expands inward, toward the heart.

When pericardial effusion puts pressure on the heart, the pumping chambers of theheart fail to fill completely, and one or more chambers may partially collapse. Thiscondition, called tamponade (tam-puh-NAYD), causes poor blood circulation and an

inadequate supply of oxygen to the body. Tamponade is a life-threatening condition ifleft untreated.

Preparing for your appointment

How much you can do to prepare for an appointment will depend on a few factors:

If you are experiencing chest pain that lasts more than a few minutes, are having

difficulty breathing or have had an unexplained fainting spell, have someone take you to

the emergency room, or call 911 or emergency medical help.

If you have any nonemergency symptoms that may be related to pericardial effusion or

another heart condition, call your doctor.

If you have nonemergency symptoms and were recently treated for a heart attack or

had heart surgery of any kind, you likely have instructions for how to follow up with your

heart specialist (cardiologist) or primary care doctor if you experience any

complications.

If you have nonemergency symptoms and have time to prepare for your appointment,the following suggestions may help you make the best use of the time with your primarycare doctor or cardiologist.

What you can do

Write down any symptoms you're experiencing, including any that may seem

unrelated to your heart or breathing.



Make a list of all medications, as well as any vitamins or supplements, that you're

taking.

Take a family member or friend along, if possible. Sometimes it can be difficult to

remember all the information provided to you during an appointment. Someone who

accompanies you may remember something that you missed or forgot.

Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you makethe most of your time. Some questions you might ask include:

What is causing my symptoms?

If I have a disease of the pericardium, can we determine the underlying cause?

What kinds of tests do I need?

How severe is my condition?

I have other health conditions. How can I best manage these conditions together?

What treatment do you recommend?

What to expect from your doctorYour doctor is likely to ask you a number of questions. Being ready to answer them mayreserve time to go over any points you want to spend more time on. Your doctor mayask:

When did you first begin experiencing symptoms?

Have your symptoms been continuous or occasional?

Have you recently had cold or flu symptoms?

Do you have any chronic health conditions?

What, if anything, seems to improve your symptoms? For example, is chest pain less

severe when you sit and lean forward?

What, if anything, appears to worsen your symptoms? For example, are your symptoms

worse when you're lying down? Are they worse when you're more active?

Tests and diagnosis



Your doctor will do a series of tests to look for pericardial effusion, identify possiblecauses and determine treatment. For some of the exams, your doctor may refer you toa cardiologist.

Medical exam

Your doctor will perform a medical exam. In particular, he or she will listen to your heartwith a stethoscope. If your pericardium is inflamed, your doctor may hear a high-pitched, scratchy sound called a friction rub. If there's a large amount of fluidaccumulated, your heartbeat may be muffled or sound distant.

EchocardiogramA commonly used test to diagnose pericardial effusion is an echocardiogram. Anechocardiogram uses sound waves to create real-time images of your heart. With thisprocedure, a cardiologist can see the extent of pericardial effusion based on the amountof space present between the two layers of the pericardium. An echocardiogram canalso show decreased heart function due to pressure on the heart (tamponade). Your

cardiologist may be able to see whether one or more chambers of the heart havecollapsed and how efficiently your heart is pumping blood. There are two types ofechocardiograms:

Transthoracic echocardiogram. This device uses a sound-emitting device

(transducer) that is placed on your chest over your heart.

Transesophageal echocardiogram. This type of echocardiogram uses a tiny

transducer on a tube that's inserted down your esophagus, the part of the digestive tract

that runs from the throat to the stomach. Because the esophagus lies close to the heart,

having the transducer placed there provides a detailed image of the heart.

ElectrocardiogramAn electrocardiogram— also called an ECG or EKG — records electrical signals asthey travel through your heart. Your cardiologist can look for patterns among thesesignals that suggest tamponade.

Chest X-ray A chest X-ray may show an enlarged silhouette of your heart if the amount of fluid in thepericardium is large.

Other imaging technologiesComputerized tomography (CT) and magnetic resonance imaging (MRI) are imagingtechnologies that can detect pericardial effusion, although they're not generally used tolook for the disorder. However, pericardial effusion may be diagnosed when these testsare done for other reasons.



Other tests If your doctor finds evidence of pericardial effusion, he or she may order blood tests orother diagnostic tests to identify an underlying cause.

Treatments and drugs

Treatment for pericardial effusion will depend on how much fluid has accumulated, whatis causing the effusion, and whether pericardial effusion has caused or is likely to causetamponade — decreased heart function due to pressure on the heart. Treating theunderlying cause of pericardial effusion — such as pericarditis or uremia — oftencorrects the problem.

Anti-inflammatory medicationsIf you don't have tamponade or there's no immediate threat of tamponade, your doctormay prescribe one of the following to treat inflammation of the pericardium that may becontributing to pericardial effusion:

Aspirin

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin (Indocin) or

ibuprofen (Advil, Motrin, others)

Colchicine(Colcrys)

If you don't respond to medications or you have recurring pericardial effusion after asuccessful treatment, your doctor may prescribe a corticosteroid, such as prednisone.

Invasive proceduresIf anti-inflammatory treatments don't correct the problem, if you have tamponade or ifyou're at risk of tamponade, your cardiologist will likely recommend one of the followingprocedures to drain fluids or prevent fluids from accumulating again.

Pericardiocentesis. With this procedure, your doctor uses a needle to enter the

pericardial space and then a small tube (catheter) to drain fluid from the pericardium.

The doctor will use imaging devices — either echocardiography or a type of X-ray

technology called fluoroscopy— to guide the work. Your heart is monitored during the

procedure with an ECG machine. In most cases, the catheter will be left in place to

drain the pericardial space for a few days to help prevent reaccumulation of fluid.

Open-heart surgery. If there's bleeding into the pericardium, especially due to recent

heart surgery or other complicating factors, you may undergo surgery to drain the

pericardium and repair any related damage. Occasionally, a surgeon may drain the



pericardium and create a "passage" that allows it to drain as necessary into the

abdominal cavity where the fluid can be absorbed.

Intrapericardial sclerosis. With this procedure, a solution is injected into the space

between the two layers of the pericardium that essentially seals the layers together.

This procedure is usually used if you have recurring pericardial effusion or if the effusion

is caused by cancer.

Pericardiectomy. Pericardiectomy is the surgical removal of all or a portion of the

pericardium. This rarely performed procedure is usually reserved for treatment of

recurring pericardial effusions despite catheter drainage. The heart can function

adequately without the pericardium.

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