Therapy
There are generally three types of treatment options that can be combined depending on the cause. First, conservative treatment can be used. Depending on the cause, antibiotics (for infections), glucocorticoids or antiphlogistics (anti-inflammatory drugs) are administered.
For pain, painkillers such as acetylsalicylic acid (equivalent to Aspirin®) are also used. The second option is to puncture the pericardium. In this procedure, fluid is drained from the pericardium under ultrasound control using a hollow needle.
This is usually carried out in the case of larger effusions or if there is a suspicion of incipient compression of the heart. Surgical measures are mainly carried out in the case of “contaminated” effusions, for example if there is blood in the fluid accumulation due to trauma or if bacteria have infected the effusion. A drainage is surgically inserted. The drainage insert is also a treatment option for recurrent effusions (so-called chronic recurrent effusions).
Puncture of the pericardium
Pericardiocentesis is used to aspirate the fluid in the pericardium. In case of acute pericardial effusions, this is performed immediately in an emergency. On the one hand, the heart is to be relieved, on the other hand, the pericardial fluid (liquor pericardii) can be examined for possible pathogens, inflammatory or tumor cells, and thus the cause of the pericardial effusion can be inferred.
Pericardiocentesis is performed by the physician under monitoring of the heart function, circulation and respiration. General anesthesia is usually not necessary, but sedatives or sleeping pills are administered and the puncture site is locally anesthetized. The needle is usually inserted below the breastbone (sternum) and is performed under ultrasound guidance. In the case of larger effusions, a drainage can be placed within the same procedure, which permanently drains the pericardial water to the outside.As a rule, the procedure is well tolerated, but complications can include inflammation in the area of the puncture site, cardiac arrhythmia or injury to surrounding tissue.
Echo and ECG
In echocardiography (informally also often referred to as “heart echo”), the heart and blood flow are displayed sonographically (= by means of ultrasound). Together with the ECG, echocardiography is one of the most important examinations of the heart. A great advantage of this examination is that it can be performed without surgery, i.e. “non-invasive”.
With echocardiography of the heart, pericardial effusion can be detected quickly and, in most cases, reliably. In addition, echocardiography can be used to assess the extent of the effusion and thus further measures can be better assessed. Echocardiography can also show how much blood the heart pumps into the body and whether the heart walls are moving properly.
Narrowed atria indicate a pericardial tamponade. The ECG records the sum of the electrical voltages of all myocardial fibers and thus serves to evaluate the function of the heart muscle. If this is restricted by a pericardial effusion, this can be detected by means of an ECG.
Non-invasive methods also include the preparation of an X-ray image. In the case of pericardial effusion, the silhouette of the heart is enlarged and the heart has a so-called “Bockbeutel” shape.
