Duration
Among the most common causes of water accumulation in the pericardium are various infectious diseases, such as tuberculosis, diphtheria, Coxsackie viruses, HIV or herpes. However, frequently existing autoimmune diseases, such as rheumatoid arthritis or lupus erythematosus, can also cause pericardial effusion. Other triggers can be metabolic diseases (e.g. uremia), malignant tumors or metastases, traumas, or a heart attack.
More rarely, medical interventions on the heart can also lead to water in the pericardium, e.g. after operations, pacemaker implantations or after radiotherapy in the chest area. Up to 30% of people have water in their pericardium following a heart attack. As long as it does not cause additional discomfort, it does not affect the healing process and does not need to be treated.
However, the water can also be caused by an autoimmune inflammation of the pericardium. In addition to fluid accumulation, fever and chest pain may occur. This clinical picture is then called Dressler syndrome.
The inflammation usually develops in the second to third week after the heart attack, but can also occur days to weeks after the heart attack. In very rare cases, the water in the pericardium can prevent the heart from expanding and thus disturb its pumping function. In such a case, it is necessary to empty the fluid.
The accumulation of fluid, especially blood, in the pericardium is a common side effect of heart surgery, especially after bypass surgery. This is usually harmless and in the majority of cases it disappears by itself. Less frequently, tamponade (a disturbance of the heart function due to pressure) occurs, which must then be emptied by the doctor as quickly as possible.
Very rarely, fluid accumulation in the pericardium can occur after pacemaker implantation or stenting. The coronary arteries could have been damaged during the procedure and lead to permanent bleeding. The heart muscle itself can also be injured.
In older patients in particular, the surgical tool may damage the heart wall to such an extent that it tears or becomes permeable. In any case, this is an acute emergency, as it can lead to pericardial tamponade. In rare cases, the so-called postcardiotomy syndrome can occur after heart surgery.
In this case the envelope of the heart becomes inflamed due to the physical irritation during the heart operation. No pathogens are involved in this inflammation. Nevertheless, in addition to the water in the pericardium, a fever can occur.
In the case of pneumonia, the body’s immune response causes inflammatory cells to float in together with fluid. This fluid normally collects in the lungs. However, in severe cases, fluid can also enter the pericardium, causing water to accumulate in the pericardium.
The most serious complication is pericardial tamponade, in which the pericardium is so full of fluid that there is not enough room for the heart. This results in a deterioration of the pumping performance and can lead to heart failure. Cancer can cause fluid to accumulate in various cavities of the body.
These are called malignant effusions. The causes of fluid accumulation are numerous. For one, the tumor itself, for example due to strong growth of the lymph nodes, can cause lymph congestion and produce an effusion.
Organs such as the heart, kidneys or liver are also often damaged by the harmful influence of the tumor. As a result, imbalances in the blood can occur, leading to water retention and effusions in many areas of the body, including the pericardium. It is not uncommon for the fluid accumulations to occur as a secondary consequence of the tumor’s destruction.
Infections with fungi, viruses or bacteria can also develop in a favored manner and lead to water in the pericardium. Cancers that lead to fluid accumulation in the pericardium in particular are breast cancer and lung cancer, but also leukaemias. Chemotherapy involves drugs that are directed against the cancer cells and are intended to impede and destroy them in their growth.
The drugs that are administered vary with each type of cancer and therefore cause different side effects.In many cases, chemotherapy can also attack the body’s own cells, which leads to the many side effects. Some cancer drugs are also classified as toxic to the heart, which means that they attack the heart cells. The destruction of the heart cells can also cause dangerous accumulations of water in the pericardium.
In many cases, it cannot be determined exactly whether the cancer itself or the chemotherapy has caused an effusion in the pericardium. Radiation therapy, another pillar of cancer treatment, can also damage heart cells and lead to effusions. The heart is particularly at risk in the case of heart tumors, lung tumors or tumors of the mediastinum in the chest cavity.
Here, late effects can still occur decades after the onset of cancer. Anorexia can lead to water accumulation in the pericardium. This rarely leads to serious complications.
It is much more likely to be an expression of the severity of anorexia, because the lower the BMI (body mass index), the greater the probability of water accumulating in the pericardium. However, when the weight is normalized, the water in the pericardium usually disappears as well. The accumulation of water is caused by the decrease in muscle mass of the heart and the fatty tissue surrounding it, so that the heart becomes too small for the pericardium in relative terms.
Another explanation is that anorectics often have too little protein in their blood. The protein normally retains the fluid in the vessel. If there is too little protein, it is more likely to accumulate fluid in body cavities.
This is also the cause of hunger oedema. In babies, the accumulation of water in the pericardium is very rare. This is mainly caused by bacterial or viral infections, but also by effusions after heart surgery. In the foetus, accumulation of fluid during pregnancy can be a sign of serious diseases such as hydrops fetalis, a serious fetal heart defect, heart tumors or genetic diseases (trisomy 21).
