Pericardial effusion (per-e-KAHR-dee-ul uh-FU-zhun) is the accumulation of too much fluid in the double-layered, sac-like structure around the heart (pericardium).
The space between the layers normally contains a thin layer of fluid. But if the pericardium is diseased or injured, the resulting inflammation can lead to excess fluid. Fluid can also build up around the heart without inflammation, such as from bleeding after a chest trauma.
Pericardial effusion puts pressure on the heart, affecting the heart's function. If untreated, it can lead to heart failure or death.
You can have significant pericardial effusion without signs or symptoms, particularly if the fluid has increased slowly.
If pericardial effusion symptoms do occur, they might include:
- Shortness of breath or difficulty breathing (dyspnea)
- Discomfort when breathing while lying down (orthopnea)
- Chest pain, usually behind the breastbone or on the left side of the chest
- Chest fullness
When to see a doctor
Call 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 fainting spell.
See your doctor if you have shortness of breath.
Pericardial effusion can result from inflammation of the pericardium (pericarditis) in response to illness or injury. Pericardial effusion can also occur when the flow of pericardial fluids is blocked or when blood accumulates within the pericardium, such as from a chest trauma.
Sometimes the cause can't be determined (idiopathic pericarditis).
Causes of pericardial effusion can include:
- Inflammation of the pericardium following heart surgery or a heart attack
- Autoimmune disorders, such as rheumatoid arthritis or lupus
- 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
- Waste products in the blood due to kidney failure (uremia)
- Underactive thyroid (hypothyroidism)
- Viral, bacterial, fungal or parasitic infections
- 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
Depending on how quickly pericardial effusion develops, the pericardium can stretch somewhat to accommodate the excess fluid. However, too much fluid causes the pericardium to put pressure on the heart, which keeps the chambers from filling completely.
This condition, called tamponade (tam-pon-AYD), results in poor blood circulation and an inadequate supply of oxygen to the body. Tamponade is life-threatening and requires emergent/urgent attention.
If your doctor suspects you have pericardial effusion, he or she will do a series of tests to look for it, identify possible causes and determine treatment.
Your doctor will perform a medical exam, including listening to your heart with a stethoscope.
An echocardiogram uses sound waves to create real-time images of your heart. With this procedure, a cardiologist can see the extent of pericardial effusion based on the amount of space between the two layers of the pericardium. An echocardiogram can also show decreased heart function due to pressure on the heart (tamponade).
Your cardiologist might be able to see whether one or more chambers of the heart have collapsed and how efficiently your heart is pumping blood. There are two types of echocardiograms:
- Transthoracic echocardiogram. This test uses a sound-emitting device (transducer) that is placed on your chest over your heart.
- Transesophageal echocardiogram. A tiny transducer on a tube is put down the part of your digestive tract that runs from your throat to your stomach (esophagus). Because the esophagus lies close to the heart, having the transducer placed there often provides a more-detailed image of the heart.
An electrocardiogram — also called an ECG or EKG — records electrical signals as they travel through your heart. Your cardiologist can look for patterns that suggest tamponade.
This can show an enlarged heart silhouette if the amount of fluid in the pericardium is large.
Other imaging technologies
Computerized tomography (CT) scans and magnetic resonance imaging (MRI) are imaging technologies that can detect pericardial effusion, although they're not generally used to look for the disorder. However, pericardial effusion may be diagnosed when these tests are done for other reasons.
If there's evidence of pericardial effusion, your doctor might order blood tests or other diagnostic tests to identify a cause.
Treatment for pericardial effusion will depend on how much fluid has accumulated, what's causing the effusion and whether you have or are likely to develop cardiac tamponade. Treating the cause of pericardial effusion often corrects the problem.
Medications that reduce inflammation
If you don't have tamponade or there's no immediate threat of tamponade, your doctor might prescribe one of the following to treat inflammation of the pericardium that may be contributing to pericardial effusion:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin (Indocin) or ibuprofen (Advil, Motrin IB, others)
- Colchicine (Colcrys)
- Corticosteroid, such as prednisone
If anti-inflammatory treatments don't correct the problem, if you have a large collection of fluid causing symptoms and making you more prone to tamponade, or if you have tamponade, your cardiologist will likely recommend one of the following procedures to drain fluids or prevent fluids from accumulating again.
Drain the fluid. Your doctor can enter the pericardial space with a needle and then use a small tube (catheter) to drain fluid — a procedure called pericardiocentesis.
The doctor will use imaging devices — either echocardiography or a type of X-ray technology called fluoroscopy — to guide the work. An ECG machine monitors your heart during the procedure. In most cases, the catheter will be left in place to drain the pericardial space for a few days to help prevent the fluid from building up again.
- Open heart surgery. If there's bleeding into the pericardium, especially due to recent heart surgery or other complicating factors, you might have surgery to drain the pericardium and repair 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.
- Open the layers. Balloon pericardiotomy is a rarely performed procedure in which a deflated balloon is inserted between the layers of the pericardium and inflated to stretch them.
- Remove the pericardium. The surgical removal of all or part of the pericardium (pericardiectomy) is usually reserved for treatment of recurring pericardial effusions despite catheter drainage.
If your pericardial effusion is discovered as a result of a heart attack or other emergency, you won't have time to prepare for your appointment. Otherwise, you'll likely start by seeing your primary care provider. Or you might be referred immediately to a cardiologist.
What you can do
When you make the appointment, ask if there's anything you need to do in advance, such as fasting before a specific test. Make a list of:
- Your symptoms, including any that seem unrelated to your heart or breathing
- Key personal information, including major stresses, recent life changes and medical history
- All medications, vitamins or supplements you take, including doses
- Questions to ask your doctor
Take a family member or friend along, if possible, to help you remember the information you receive.
For pericardial effusion, some basic questions to ask your doctor include:
- What's likely causing my symptoms?
- What tests do I need?
- Should I see a specialist?
- How severe is my condition?
- What's the best course of action?
- I have other health conditions. How can I best manage these conditions together?
- Are there brochures or other printed material I can have? What websites do you recommend?
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:
- When did your symptoms begin?
- Do you have symptoms all the time or do they come and go?
- What, if anything, seems to improve your symptoms? For example, is your 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?