Pericardial Effusion

What is pericardial effusion?

Pericardial effusion (per-i-KAHR-dee-al e-FU-zhun) is a condition where there is too much fluid in the pericardium. The pericardium is a two-layer sac that surrounds the heart. It holds the heart in the center of the chest and protects it from infections. The sac contains a small amount of clear fluid between its layers. This allows the heart to move smoothly against other organs in the chest as it beats. With pericardial effusion, the amount of fluid in the sac increases, and it may become cloudy, bloody, or thick. These changes may affect how the heart works. These changes can come on fast and be life-threatening, or be chronic (happens slowly, get worse, and last a long time).

What causes pericardial effusion?

This condition may be caused by any of the following:

• Diseases: Autoimmune diseases, such as rheumatoid arthritis, may cause this condition. Other diseases, such as cancer, having a low level of thyroid hormone, or kidney failure may also cause this condition.
  
  
• Germs: Viruses, bacteria, or parasites (small living creatures), may infect the sac and cause this condition. Infection in other areas of the body may spread and reach the sac. Infections that cause this condition include tuberculosis and HIV.
  
  
• Inflammation: Pericarditis, which is inflammation (swelling) of the sac. Ask your caregiver for more information about pericarditis.
  
  
• Injury to the sac: Trauma or accidents, where there is a hard blow to the chest, may damage the sac. The sac can also be injured by having a heart attack.
  
  
• Pregnancy: The fluid in the sac may increase in amount or change in appearance during pregnancy.
  
  
• Procedures: Procedures done on the chest, such as surgery or radiation therapy.
  
  
• Other: In some cases, the cause of this condition is unknown.

What are the signs and symptoms of pericardial effusion?

You may have any of the following:

• Chest pain.
  
  
• Cough.
  
  
• Feeling light-headed, loss of consciousness.
  
  
• Swelling of your legs and feet.
  
  
• Trouble breathing, especially when lying down.
  
  
• Trouble eating and swallowing food.

How is pericardial effusion diagnosed?

Your caregiver will ask about your medical history and the medicines you are taking. He will do a physical exam on you. You may also have any of the following tests:

• 12-lead ECG: This test, also called an EKG, helps caregivers look for damage or problems in the heart. Sticky pads are placed on your chest, arms, and legs. Each sticky pad has a wire that is hooked to a machine or TV-type screen. A short period of electrical activity in your heart muscle is recorded. Caregivers will look closely for certain problems or changes in how your heart is working.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Radiology exams:
  
  
  • Chest x-ray: This is a picture of your lungs and heart. Chest x-rays may show tumors or fluid around the heart and lungs.
    
    
  • Echocardiogram: This test is also called an echo. It uses sound waves to show pictures of the size and shape of your heart, and how your heart moves when it is beating. An echo can also see fluid around the heart or problems with your heart valves.
    
    
  • Imaging tests: Tests such as computerized tomography scan (CT scan) or magnetic resonance imaging (MRI) take very detailed pictures of your chest. This allows your caregiver to see problems in the heart.
  
  
• Pericardiocentesis: This is a procedure used to take a sample of fluid from the pericardial sac with a needle. The fluid is sent to a lab for tests.

How is pericardial effusion treated?

You may need treatment of the disease causing your pericardial effusion, such as dialysis for kidney failure or surgery for cancer. You may also need any of the following:

• Medicines: Antibiotics may be used to treat an infection that is causing your pericardial effusion. You may receive medicines to treat other conditions causing you to have a pericardial effusion or making it worse. These may include anti-inflammatory drugs, such as aspirin or steroids, if you have pericarditis.
  
  
• Procedures: You may have any of the following to help your heart beat properly and remove extra fluid:
  
  
  • Balloon procedure: This procedure is done in the cardiac cath lab. A needle is put into the sac and a guidewire is threaded through the needle. The needle is then removed. A small tube (catheter), with a not-yet-inflated balloon at its end, is passed over the guidewire into the correct position in the sac. The balloon is inflated and deflated several times to create an opening for the fluid to drain out.
    
    
  • Catheter placement: This is a procedure where a small cut (incision) is made in your chest below the breast bone. Then a catheter is put through the incision into the sac. The catheter is left in place to drain the extra fluid out of your body.
    
    
  • Needle tap: With this procedure (pericardiocentesis), the extra fluid is removed with a syringe through a needle put into your chest. This may be done to quickly remove fluid that is pressing on your heart and affecting how it beats.
    
    
  • Surgery: A surgical procedure may be done to remove part or most of the pericardial sac. It may be done through a large incision in your chest or your caregivers may use a less invasive method with smaller incisions.

Where can I get more information?

Contact the following for more information:

• National Cancer Institute
  6116 Executive Boulevard, Suite 300
  Bethesda , MD 20892-8322
  Phone: 1- 800 - 422-6237
  Web Address: http://www.cancer.gov
  

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Learn more about Pericardial Effusion