Pericardial effusion is the accumulation of excess fluid around the heart.

The heart is surrounded by a double-layered, sac-like structure called the pericardium. The space between the layers normally contains a very small amount of fluid.

Pericardial effusion is often related to inflammation of the pericardium due to disease or injury, but pericardial effusion can occur when there is no inflammation. Pericardial effusion can also result from the accumulation of blood after a surgical procedure or injury.

When the volume of fluid exceeds the pericardium’s “full” level, pericardial effusion puts pressure on the heart, causing poor heart function. If left untreated, pericardial effusion can cause heart failure or death.

Pericardial effusion symptoms may include:

  • Shortness of breath or difficulty breathing (dyspnea)
  • Shortness of breath when lying down (orthopnea)
  • Chest pain, usually behind the breastbone or on the left side of the chest
  • Cough
  • Painful breathing, especially when inhaling or lying down
  • Fainting or dizziness
  • Low-grade fever
  • Rapid heart rate
  • Overall sense of fatigue or weakness

You can have significant pericardial effusion and experience no signs or symptoms, particularly if the fluid has increased slowly. This is more common when the cause of pericardial effusion is cancer or a chronic inflammatory disorder, such as rheumatoid arthritis.

Inflammation of the pericardium (pericarditis) is a response to disease, injury or an inflammatory disorder that affects the pericardium. Pericardial effusion is often one component of this inflammatory response.

Pericardial effusion may also occur when the flow of pericardial fluids is blocked or when blood accumulates within the pericardium. It’s unclear how some diseases contribute to pericardial effusion, and sometimes the cause can’t be determined.

The pericardium can hold only a limited amount of excess fluid without causing complications. The inner layer of the pericardium is made of a single layer of cells that sticks to the heart. The outer layer is thicker and only somewhat elastic. When the amount of liquid reaches a certain level, the pericardium expands inward, or toward the heart.

When pericardial effusion puts pressure on the heart, the pumping chambers of the heart fail to fill completely, and one or more chambers may partially collapse. This condition, called tamponade (tam-puh-NAYD), results in poor blood circulation and an inadequate supply of oxygen to the body. Tamponade is a life-threatening condition if left untreated.

Treatment for pericardial effusion will depend on how much fluid has accumulated, what is causing the effusion, and whether pericardial effusion has caused or is likely to cause tamponade — impaired heart function due to pressure on the heart. Treating the underlying cause of pericardial effusion — such as pericarditis or uremia — often corrects the problem.

If you don’t have tamponade or there’s no immediate threat of tamponade, your doctor may prescribe one of the following to treat inflammation of the pericardium that may be contributing to pericardial effusion:

  • Aspirin
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin (Indocin) or ibuprofen (Advil, Motrin, others)
  • Colchicine

If you don’t respond to medications or you have recurring pericardial effusion after a successful treatment, your doctor may prescribe a corticosteroid, such as prednisone.

If anti-inflammatory treatments don’t correct the problem, if you have tamponade or if you’re at risk of tamponade, your cardiologist will likely recommend one of the following procedures to drain fluids or prevent fluids from accumulating again.

  • Pericardiocentesis – With this procedure, your doctor uses a needle to enter the pericardial space and then a small tube (catheter) to drain fluid from the pericardium. The doctor will use imaging devices — either echocardiography or a type of X-ray technology called fluoroscopy — to guide the work. Your heart is monitored during the procedure with an ECG machine. In most cases the catheter will be left in place to drain the pericardial space for a few days to help prevent reaccumulation of fluid.
  • Open heart surgery – If there’s bleeding into the pericardium, especially due to recent heart surgery or other complicating factors, you may undergo surgery to drain the pericardium and repair any related 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.
  • Intrapericardial sclerosis – With this procedure, a solution is injected into the space between the two layers of the pericardium that essentially seals the layers together. This procedure is usually used if you have recurring pericardial effusion or if the effusion is caused by cancer.
  • Pericardiectomy – Pericardiectomy is the surgical removal of all or a portion of the pericardium. This rarely performed procedure is usually reserved for treatment of recurring pericardial effusions despite catheter drainage. The heart can function adequately without the pericardium.

Source: MayoClinic.com