Pericardial Effusion - Causes, Symptoms, Diagnosis, Prevention, and Treatment

Introduction

Pericardial effusion is the accumulation of excess fluid in the heart and the protective sac surrounding the heart. This particular protective sac is called the pericardium. In the majority of cases, this accumulation gets resolved on its own over time but may eventually lead to the heart not functioning smoothly. The pericardium is a dual-layered protective sac encompassing the heart that is fibro-elastic in nature. It is a physical barrier that clutches the heart in place and assists in its regular functioning by lubrication. Diseases to the pericardium come into the picture if there is any swelling or when fluid starts getting filled in the pericardium. Such swellings and fluid accumulation in the pericardium are dangerous and lead to heart dysfunction. The pericardial cavity is a small area between the pericardium and the heart. When this pericardium gets filled with blood or fluid, it results in pericardial effusion.

What Happens During Pericardial Effusion?

The pericardium is a double-layered protective covering of the heart. When the heart beats, the heart slides smoothly against the pericardium. Anatomically, approximately two to three tablespoons of yellow, clear pericardial fluid linger between the protective sac of the heart. This particular fluid aids in a non-friction movement of the heart. In the case of pericardial effusion, there is an excess of pericardial fluid within the heart’s cavity. Minor cases of pericardial effusion may result in approximately a hundred milliliters of fluid while a major case may lead to an accumulation of approximately two liters of pericardial fluid.

What Are the Signs and Symptoms of Pericardial Effusion?

Chest pain is one of the most common clinical manifestations of pericardial effusion. Leaning forward and breathing may increase the discomfort caused by pericardial effusion.

Mentioned below are the signs and symptoms of pericardial effusion :

• Fever.

• Fatigue.

• Pain in the muscles.

• Shortness of breath.

• Diarrhea.

• Nausea.

• Vomiting.

• Tightness in the chest.

• Anxiety.

• Restlessness.

• Fainting.

• Abnormal heartbeat.

• Dizziness.

• Sharp stabbing kind of pain in the chest.

• Palpitations.

• Swelling in the ankles, legs, and feet.

• Pressure feeling in the chest.

• Tachycardia.

• Bradycardia.

• Atrial fibrillation.

• Sore throat.

• Joint pain.

• Extended neck veins.

• Decreased urine output.

• Chest pain that radiates to the neck and left shoulder.

• Deep inhalation turns strenuous.

• Cold and clammy skin.

• Heart palpitations.

• Lightheadedness.

What Are the Causes of Pericardial Effusion?

Pericardial effusion is caused by several underlying cardiovascular conditions. Inflammation of the pericardial sac is one of the most common causes of the accumulation of extra fluid in the sac. During a viral infection, the body releases cells to kill the virus. In case these cells enter the heart, they may inflame the heart tissues leading to pericardial effusion.

Mentioned below are a few causes of pericardial effusion :

• Coxsackie B virus.

• EBV or Epstein-Barr virus.

• CMV or Cytomegalovirus.

• Herpes simplex virus.

• Human immunodeficiency virus.

• Hepatitis C.

• Parvovirus.

• Chlamydia.

• Streptococcal bacterial infection.

• Mycoplasma infection.

• Treponema infection.

• Borrelia infection.

• Toxins such as alcohol and drugs like cocaine.

• Lead toxin.

• Toxins released after spider bites.

• Wasp stings.

• Toxins after a snakebite.

• Chemotherapy.

• Radiation therapy.

• Allergies to certain medications and antibiotics.

• Graves disease.

• Postpartum cardiomyopathy.

• Allergic reaction to tetanus toxoid.

• Toxoplasmosis.

• Giant cell disease.

• Swelling of the pericardium post a heart attack.

• Reaction to certain medications.

• Autoimmune and metabolic diseases such as hypothyroidism and chronic kidney failure.

• Radiation therapy.

How to Diagnose Pericardial Effusion?

The correct diagnosis of pericardial effusion is made after the healthcare provider has taken a thorough medical history, especially cardiovascular history. In addition, understanding the patient’s symptoms and conducting physical examinations as well as several tests are necessary to diagnose a case of pericardial effusion.

Mentioned below are some of the go-to diagnostic tools for pericardial effusion,

• Electrocardiogram.

• Cardiac enzyme markers.

• Complete blood picture.

• Echocardiogram.

• Rheumatological screening tests.

• Viral blood tests.

• Heart muscle biopsy.

• Chest x-rays.

• Lung and other chest structures examination.

• MRI of the heart or magnetic resonance imaging of the heart.

Can Pericardial Effusion Be Prevented?

The risk of experiencing a pericardial effusion can be reduced by eating a healthy diet and exercising regularly. A balanced diet acts as fuel to the heart providing all the necessary nutrients, while regular exercise keeps the heart running similar to an engine. Depriving the heart of these two basic and fundamental requisites will only call for trouble in the near or late future. If one is already suffering from other cardiovascular diseases, a heart-healthy diet and regular consultations with the cardiologist should be made a priority.

How to Treat Pericardial Effusion?

The exact treatment of pericardial effusion depends on its severity. In case there is only a little amount of fluid, any particular treatment is not required.

Mentioned below are the treatment modalities of pericardial effusion,

• NSAIDs or nonsteroidal anti-inflammatory drugs.

• Corticosteroids.

• Colchicine.

• Pericardiocentesis or drainage of excess fluid in the cardiovascular system.

• Pericardial window.

What Are the Complications of Pericardial Effusion?

Pericardial effusion can be understood as a medical condition in which blood or fluid penetrates inside the pericardium resulting in central pressure on the heart. This penetration does not allow the heart to pump blood or function appropriately. Due to less or no blood supply from the heart, vital organs start to fail one after the other, and the body goes into shock. Regular electrocardiograms are taken to monitor the functioning of the heart. Analgesics and anti-inflammatory drugs are administered or prescribed to be taken routinely. In case of open-heart surgery or any invasive procedure, a blood transfusion may be required. Your healthcare provider is the right person to determine the principal line of treatment since each and every case of pericardial effusion are divergent on its own.

Conclusion

An episode of pericardial effusion results from fluid lodgement within the pericardium, which is the protective and lubricative sac surrounding the heart. Pericardial effusion is a medical emergency that demands instantaneous relief from pain and prompt treatment measures. Drainage of the assembled fluid within the heart’s cavity is an unavoidable management modality, which is generally invasive in nature. The outlook after treatment is satisfactorily acceptable. But this is conditional on the diagnosis being made in the nick of time. Pericardial effusion is indeed a medical crisis that puts both the patient and their family as well as the treating doctor into a tight spot. Nevertheless, it is a reversible condition that may result in a positive outlook.