A pericardial effusion is excess fluid buildup in the pericardial cavity. There are very good treatment methods and chances of recovery, only in very few cases is surgical intervention necessary.
What is a pericardial effusion?
A pericardial effusion, also known as a cardiac effusion , is an excessive accumulation of fluid between the sac around the heart and the lining of the heart.
The gap between the pericardial sac and the cardiac skin, the pericardial cavity, is also filled with some liquid in the physiological state in order to reduce the frictional resistance with every heartbeat. However, if more fluid is formed than is absorbed, fluid accumulates in the pericardial cavity and pericardial effusion occurs. If the amount of fluid in the pericardial cavity increases significantly, the heart muscle is constricted and the heart chambers can no longer fill with enough blood. See electronicsencyclopedia for Slang Testicular Inflammation.
Small or chronic pericardial effusions rarely cause symptoms because the amount of pericardial fluid is only slightly increased. Severe pericardial effusions can cause a variety of symptoms. A reduction in the pumping capacity of the heart is particularly typical. If the effusion is severe, symptoms of heart failure, such as bruising or congestion in the veins of the neck, occur.
There are many causes of pericardial effusion. These include a ventricular rupture, i.e. a tear in the heart chamber, or an aortic dissection, a bursting of the main artery.
Various infectious diseases can lead to the clinical picture of pericardial effusion, including HIV, herpes and tuberculosis. Due to the insufficient pumping capacity of the heart in the case of heart failure, a pathological accumulation of fluid in the pericardial cavity can also occur here. As a result of heart surgery, so-called postcardiotomy syndrome can occur, an inflammation of the pericardium that can lead to pericardial effusion.
Pericardial effusion is a possible symptom of some cancers, including breast cancer, leukemia, and lung cancer. Some immunological diseases such as rheumatism, Crohn’s disease or ulcerative colitis can also lead to pericardial effusion.
Symptoms, Ailments & Signs
A small pericardial effusion does not necessarily produce symptoms. Larger hematomas lead to circulatory disorders and chest pain. It can also lead to an acute drop in blood pressure. Those affected usually feel an inner restlessness that increases in intensity as the disease progresses. As a result of the reduced pumping capacity and the congestion of the inflow, accompanying symptoms such as exhaustion, breathing difficulties and cardiac arrhythmia also occur.
Those affected are generally less resilient and more quickly exhausted when exercising. The lack of oxygen supply can also cause pathological breathing noises. This is accompanied by external symptoms such as blue lips and cold or numb fingers. Due to the feeling of being unwell, an increasing loss of appetite is also noticeable.
The sufferers lose body weight as a result 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.
The patient is usually completely free of symptoms after one to two weeks. However, if the hematoma is treated too late or inadequately, serious secondary symptoms such as tachycardia or respiratory failure can occur. In severe cases, pericardial effusion can lead to death.
Diagnosis & History
The first diagnostic measure taken when a pericardial effusion is suspected is an ultrasound examination. In some cases, a computed tomography is also ordered. Fluid is then removed from the pericardial cavity and examined in the laboratory for pathogens or cancer cells.
As part of a medical history, the doctor treating you determines any existing illnesses; this is particularly important in order to narrow down the possible causes. In the case of a pericardial effusion, the anamnesis is usually unspecific. Patients usually report shortness of breath, exhaustion or coughing. The EKG shows the increased pericardial fluid surrounding the heart. In most cases, this is sufficient to establish a 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 big problem and may not require treatment. Acute pericardial effusions can usually be treated well, so that patients rarely have to reckon with consequential damage.
As a rule, there are no special complications or other serious symptoms with pericardial effusion. Surgery is also rarely necessary, especially in serious cases. In most cases, patients also suffer from heart problems due to the pericardial effusion. This leads to shortness of breath and a significantly reduced resilience of the patient.
This also leads to permanent exhaustion and tiredness and has a very negative effect on the quality of life of those affected. Coughing and hyperventilation also occur. Patients themselves complain of anxiety and, in some cases, feelings of confusion and anxiety. There is also a loss of appetite.
Due to the undersupply of the body with oxygen, pericardial effusion often leads to a blue discoloration of the skin. The inner organs can also be irreversibly damaged in the long term. Pericardial effusion is usually treated with antibiotics or painkillers. There are no complications and the course of the disease is generally positive.
When should you go to the doctor?
A mild pericardial effusion may be symptomless. A medical examination is necessary in the case of noticeable symptoms such as palpitations or an increased pulse. A larger pericardial effusion represents a medical emergency. If breathing and circulatory problems such as shortness of breath or a rapid pulse occur, the emergency services must be called immediately. If the person concerned loses consciousness, first aid must be provided.
After the first aid, the patient has to be treated as an inpatient in the hospital. After discharge from the hospital, regular follow-up examinations are necessary. It is also important to determine the cause of the pericardial effusion, which may require lengthy examinations by various specialists.
Pericardial effusion is treated by a cardiologist. Depending on the symptoms, internists and the family doctor can be involved in the therapy. Pericardial effusion is particularly common in people with pericarditis. Patients with other heart diseases also belong to the risk groups and should have the symptoms described quickly clarified by a doctor. Children, the elderly, pregnant women and people with physical problems should have unusual heart symptoms checked quickly, especially if they get worse and don’t go away on their own.
Treatment & Therapy
Treatment for pericardial effusion depends on the underlying condition. In the case of a slight pericardial effusion, for example in the context of infections, it is often sufficient to stay in bed and take it easy for a while. Nevertheless, going to the doctor is essential.
Drug therapy is useful in many cases to relieve pain and reduce inflammation. Light painkillers such as ibuprofen are usually used here . Depending on the underlying disease, a specific therapy must also be initiated, such as the administration of antibiotics for infections.
If the pericardial effusion is severe or if drug therapy does not work, a pericardial puncture is usually performed. The treating doctor penetrates the pericardial sac with a needle and removes fluid with a cannula. During the pericardial puncture, the doctor uses an echocardiography device to monitor the procedure. A puncture is usually used to obtain material for further examination in the laboratory, but a certain amount of fluid can also be removed.
If there is a large amount of fluid in the pericardial cavity, pericardial drainage must be performed. The effusion is drained through a catheter. In particularly severe, treatment-resistant cases, surgical intervention is necessary. A small window is cut in the pericardium to allow fluid to drain; this procedure is called pericardial fenestration. A pericardectomy, i.e. a complete removal of the pericardium, is only necessary in exceptional cases.
Outlook & Forecast
The outlook for patients with pericardial effusion is difficult to assess. A 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 have 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, a transplant, an accident or similarly serious incidents, including cancer. Pericardial effusion caused by tuberculosis, on the other hand, is found only rarely.
The prognosis for pericardial effusion worsens significantly if cardiac tamponade occurs due to larger accumulations of fluid. 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 pericardial sac is repeatedly loaded with larger amounts of fluid. Therefore, in addition to the technically demanding puncture, chronic pericardial effusion requires accompanying drug treatment. There is also the possibility of improving the prognosis with a transcutaneous pericardiotomy. A drain is placed instead of a puncture. This remains on site for several days.
The prognosis is rarely improved by using a catheter and a compressed air balloon. This allows the pericardial effusion to run off independently over a longer period of time.
So far, there are no specific measures to prevent pericardial effusion. Of course, as with almost every heart disease, a healthy lifestyle, avoiding alcohol and smoking, as well as a healthy amount of sport and exercise can also contribute to the prophylaxis against pericardial effusion.
After treatment of a pericardial effusion, at least one check-up by the responsible general practitioner or cardiologist is necessary. The doctor first asks about the typical symptoms that can occur in connection with an effusion and clarifies open questions from the patient. As part of the anamnesis, the dose of the prescribed medication is also checked and adjusted if necessary.
If side effects or interactions occur, the doctor must be informed as part of the aftercare. The physical examination focuses on palpating the heart, listening to it, and possibly doing an ultrasound scan. Based on the imaging data, the doctor can determine relatively quickly whether the effusion has subsided. Depending on the outcome of the follow-up examination, further measures can be taken.
If no abnormalities were found, no further follow-up appointments are usually necessary. However, the patient should have an examination of the heart at least once a year. In the case of a difficult course with recurring effusions, regular check-ups are necessary. Small effusions must be observed so that an operation can be initiated quickly if necessary. In the case of recurrent pericardial effusions in particular, close consultation with the doctor is necessary.
You can do that yourself
Sufferers of a pericardial effusion are well advised to remain calm. In many cases rest and sufficient sleep already lead to an alleviation of the symptoms. Relaxation methods, which the person concerned can carry out independently at any time, help to reduce stress and hectic pace. Yoga, meditation or autogenic training techniques can be used to release inner tension and build up new strength.
Avoid being overweight or gaining a lot of weight. This puts additional strain on the heart and, as the disease progresses, can no longer meet the demands of the organism. Your own body weight should ideally be within the BMI specifications. A healthy and balanced diet is important for maintaining health and strengthening the body’s own defences. The consumption of harmful substances such as alcohol or nicotine should be avoided.
The patient helps himself if he drinks enough fluids and spends time in the fresh air every day. Your own rooms are to be ventilated regularly and refilled with new oxygen. In addition, the sleeping conditions should be optimized so that the body can recover sufficiently during the rest phases. Compliance with bed rest is necessary. Sporting activities or everyday obligations are to be avoided and should be taken over by relatives or friends.