Pericardial effusion is an excessive accumulation of fluid in the pericardial cavity. There are very good treatment methods as well as chances of cure, only in very few cases surgical intervention is necessary.
What is pericardial effusion?
Pericardial effusion, also called pericardial effusion, is when there is an excessive buildup of fluid between the pericardium and the lining of the heart. The gap between the pericardium and the pericardium, the pericardial cavity, is filled with some fluid even in the physiologic state to reduce frictional resistance with each heartbeat. However, if more fluid is produced than is reabsorbed, fluid accumulates in the pericardial cavity and pericardial effusion occurs. If the amount of fluid in the pericardial cavity increases greatly, the heart muscle becomes constricted and the heart chambers can no longer fill sufficiently with blood. In small or chronic pericardial effusions, symptoms rarely occur because the amount of pericardial fluid is only slightly increased. In more severe pericardial effusions, a variety of symptoms may occur. A reduction in the pumping capacity of the heart is particularly typical. In severe effusions, symptoms of heart failure, such as blue lips or blood stasis of the jugular veins, occur.
Causes
There are many causes of pericardial effusion. These include ventricular rupture, a tear in the ventricle of the heart, or aortic dissection, a bursting of the aorta. Various infectious diseases can lead to the clinical picture of pericardial effusion, including HIV, herpes and tuberculosis. Pathological accumulation of fluid in the pericardial cavity may also occur due to the insufficient pumping capacity of the heart in heart failure. As a result of heart surgery, the so-called postcardiotomy syndrome may occur, an inflammation of the pericardium that can lead to pericardial effusion. Pericardial effusion is a possible symptom in some cancers, including breast cancer, leukemia and lung cancer. Some immunologic diseases, such as rheumatoid arthritis, Crohn’s disease, and ulcerative colitis, can also lead to pericardial effusion.
Symptoms, complaints, and signs
A small pericardial effusion does not necessarily cause symptoms. Larger hematomas cause circulatory problems and chest pain. In addition, an acute drop in blood pressure may occur. Affected individuals usually experience inner restlessness, which increases in intensity as the disease progresses. As a result of the reduced pumping capacity and the congestion of the influence, accompanying symptoms such as fatigue, breathing difficulties and cardiac arrhythmias also occur. Those affected are generally less able to work under pressure and more quickly exhausted during physical activity. The lack of oxygen supply can also cause abnormal breathing noises. This is accompanied by external symptoms such as blue lips and cool or numb fingers. Due to the indisposition, an increasing loss of appetite is also noticeable. Sufferers subsequently lose body weight and often suffer from deficiency symptoms that exacerbate the original symptoms. If a pericardial effusion is detected early, there are usually no further complications. The symptoms subside as soon as the hematoma has receded. Usually, the patient is completely symptom-free again after one to two weeks. However, if the hematoma is treated too late or inadequately, serious secondary symptoms such as tachycardia or respiratory failure may develop. In severe cases, pericardial effusion can lead to death.
Diagnosis and course
The first diagnostic measure taken when pericardial effusion is suspected is an ultrasound examination. In some cases, a computed tomography scan is also ordered. Fluid is then collected from the pericardial cavity and examined in the laboratory for pathogens or cancer cells. In the course of taking the patient’s medical history, the treating physician determines any existing diseases; this is particularly important in order to be able to narrow down the possible causes. In the case of pericardial effusion, the medical history is usually nonspecific. Patients usually report shortness of breath, fatigue or cough. ECG shows increased pericardial fluid surrounding the heart. In most cases, this is sufficient to make the diagnosis. The further course of a pericardial effusion depends on the severity of the effusion, the underlying disease and the treatment.Chronic pericardial effusions are usually not a major problem and may not need to be treated. Acute pericardial effusions can usually be treated well, so patients rarely have to deal with secondary damage.
Complications
Pericardial effusion does not usually result in any particular complications or other serious symptoms. Surgical intervention is also necessary only rarely and mainly in severe cases. In most cases, patients also suffer from heart problems due to pericardial effusion. This results in shortness of breath and a marked reduction in the patient’s ability to cope with stress. This also causes permanent fatigue and tiredness, which has a very negative effect on the quality of life of the patient. Coughing and hyperventilation also occur. Patients themselves complain of inner restlessness and in some cases feelings of confusion and anxiety. Loss of appetite also occurs. Due to the undersupply of oxygen to the body, it is not uncommon for pericardial effusion to also cause a blue discoloration of the skin. It can also cause irreversible damage to the internal organs in the long run. Treatment of pericardial effusion is usually done with the help of antibiotics or painkillers. No complications occur, and the course of the disease is generally positive.
When should you go to the doctor?
Mild pericardial effusion may progress without symptoms. Medical evaluation is necessary if there is noticeable discomfort, such as a pounding heartbeat or an elevated pulse. A major pericardial effusion is a medical emergency. If breathing and circulatory problems such as shortness of breath or a rapid pulse occur, emergency medical services must be called immediately. If the affected person loses consciousness, first aid must be administered. Following initial treatment, the patient must be hospitalized. After discharge from the hospital, regular follow-up examinations are necessary. In addition, the cause of the pericardial effusion must be determined, which may require lengthy examinations by various specialists. A pericardial effusion is treated by a cardiologist. Depending on the symptoms, internists and the family physician may be involved in the therapy. Persons suffering from pericarditis are particularly likely to suffer from pericardial effusion. Patients with other heart diseases also belong to the risk groups and should have the symptoms described clarified by a physician without delay. Children, the elderly, pregnant women, and those in physical distress should have any unusual symptoms around the heart examined quickly, especially if they become more severe and do not resolve on their own.
Treatment and therapy
Treatment of pericardial effusion depends on the underlying condition. In the case of mild pericardial effusion, such as that caused by infection, it is often sufficient to maintain bed rest and take it easy for some time. Nevertheless, a visit to the doctor is indispensable. To alleviate pain and reduce inflammation, drug therapy is useful in many cases. Usually, light painkillers, such as ibuprofen, are used here. Depending on the underlying disease, specific therapy must also be initiated, such as the administration of antibiotics for infections. If the pericardial effusion is severe or the drug therapy does not work, a pericardiocentesis is usually performed. In this procedure, the attending physician penetrates the pericardium with a needle and removes fluid with a cannula. During the pericardiocentesis, the physician uses an echocardiography device to monitor the procedure. Most often, a puncture is used to obtain material for further examination in the laboratory, but a certain amount of fluid may also be removed. If there is a large amount of fluid in the pericardial cavity, pericardial drainage must be performed. This involves draining the effusion through a catheter. In particularly severe cases that are resistant to treatment, surgical intervention is necessary. This involves cutting a small window in the pericardium so that the fluid can drain out; this procedure is known as pericardial fenestration. Only in exceptional cases is a pericardiectomy, or complete removal of the pericardium, necessary.
Outlook and prognosis
The outlook for patients with pericardial effusion is difficult to assess.Pericardial effusion is only spoken of when the normal amount of tissue fluid in the pericardium is exceeded. In the case of larger amounts of fluid, the pericardium may need to be punctured. The prognosis depends, among other things, on whether the pericardial effusion is acute or chronic. Acute pericardial effusion can occur as a result of a heart attack, transplant, accident, or similar serious events, up to and including cancer. In contrast, pericardial effusion caused by tuberculosis is rarely found. The prognosis for pericardial effusion worsens significantly when major fluid collections cause cardiac tamponade. The heart can no longer perform its normal work. A puncture can be life-saving. It improves the prognosis. The only question is how long-term. If the pericardial effusion is chronic, the pericardium is repeatedly loaded with larger amounts of fluid. Therefore, in addition to the technically demanding puncture, chronic pericardial effusion requires concomitant drug treatment. There is also the possibility of improving the prognosis by transcutaneous pericardiotomy. In this case, a drain is placed instead of a puncture. This remains in place for several days. Rather rarely, the prognosis is improved by the use of a catheter and a compressed air balloon. This allows the pericardial effusion to drain on its own for a longer period of time.
Prevention
Specific measures to prevent pericardial effusion do not yet exist. Of course, as with almost any disease of the heart, a healthy lifestyle, abstaining from alcohol and smoking, and a healthy amount of exercise and sport can also help to prevent pericardial effusion.
Follow-up
After treatment of a pericardial effusion, at least one follow-up examination by the responsible primary care physician or cardiologist is necessary. The physician first asks about the typical complaints that may occur in connection with an effusion and clarifies any open questions the patient may have. As part of the medical history, the dose of the prescribed medication is also checked and adjusted if necessary. If side effects or interactions occur, the physician must be informed of them during follow-up. The physical examination focuses on palpation of the heart, a listening test and, if necessary, the taking of an ultrasound image. Based on the imaging data, the physician can determine relatively quickly whether the effusion has resolved. Depending on the outcome of the follow-up examination, further measures can be taken. If no abnormalities are detected, no further follow-up appointments are usually necessary. However, the patient should have a cardiac examination at least once a year. In case of a difficult course with recurrent effusions, regular check-ups are necessary. Small effusions must be observed so that surgery can be initiated quickly if necessary. Close consultation with the physician is particularly necessary for recurrent pericardial effusions.
Here’s what you can do yourself
Sufferers of a pericardial effusion are well advised to remain calm. In many cases, rest and adequate sleep already lead to relief of symptoms. In the reduction of stress and hectic, relaxation procedures help, which the affected person can perform at any time on his own responsibility. Yoga, meditation or autogenic training techniques can relieve inner tension and build up new strength. Overweight or a strong weight increase are to be avoided. This puts additional strain on the heart and, in the further course, it can no longer cope with the demands of the organism. One’s own body weight should ideally be within the BMI guidelines. A healthy and balanced diet is important for maintaining health and strengthening the body’s defenses. The consumption of harmful substances such as alcohol or nicotine should be avoided. The patient helps himself by drinking enough fluids and spending time in the fresh air every day. The patient’s own rooms should be ventilated regularly and replenished with new oxygen. In addition, sleeping conditions should be optimized so that the body can recover sufficiently during rest periods. The observance of a bed rest is necessary. Sporting activities or everyday commitments are to be refrained from and should be taken over by relatives or friends.
